Healthcare Provider Details

I. General information

NPI: 1144567850
Provider Name (Legal Business Name): STEPHENS FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 BALLARDS-CORNERS
HINESBURG VT
05461-6700
US

IV. Provider business mailing address

82 BALLARDS-CORNERS
HINESBURG VT
05461-6700
US

V. Phone/Fax

Practice location:
  • Phone: 802-482-3155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN03010
License Number StateRI

VIII. Authorized Official

Name: DR. DAVID A STEPHENS
Title or Position: DENTIST
Credential: DMD
Phone: 802-482-3155