Healthcare Provider Details

I. General information

NPI: 1134143803
Provider Name (Legal Business Name): SIOBHAN MARIE STEPHEN DMD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 TIMBER LANE
SOUTH BURLINGTON VT
05403-7282
US

IV. Provider business mailing address

44 TIMBER LANE
SOUTH BURLINGTON VT
05403-7282
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-6725
  • Fax: 802-864-0277
Mailing address:
  • Phone: 802-860-6725
  • Fax: 802-864-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0160002093
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: