=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093357931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN T STEPHENS DMD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2019
-----------------------------------------------------
Last Update Date | 04/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5408 W. ADAMS SUITE 102
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-231-4946
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 258 ARROWHEAD POINT RD
-----------------------------------------------------
City | BELTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76513-6765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-435-6079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. RYAN T STEPHENS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 502-435-6079
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------