Healthcare Provider Details

I. General information

NPI: 1336207604
Provider Name (Legal Business Name): STEPHEN BRADLEY BOOKMYER DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ROUND ROCK AVE
ROUND ROCK TX
78681-4010
US

IV. Provider business mailing address

2100 ROUND ROCK AVE
ROUND ROCK TX
78681-4010
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-3855
  • Fax:
Mailing address:
  • Phone: 512-244-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number18581
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: