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General NPI Number Information
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NPI Number | 1083054431
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Entity Type | Individual
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Provider Name | STEPHANIE NICOLE CERVETTO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2013
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Last Update Date | 06/30/2013
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Provider Practice Location Address
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Address Line | 2541 NORTHWEST LOOP
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City | STEPHENVILLE
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State | TX
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Zip | 76401-1601
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Country | US
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Telephone | 254-968-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 127 BLUE JAY ST
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City | STEPHENVILLE
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State | TX
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Zip | 76401-5926
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Country | US
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Telephone | 254-485-4219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29195
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License Number State | TX
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