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General NPI Number Information
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NPI Number | 1669555454
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Entity Type | Individual
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Provider Name | STEPHEN ANDREW TRAGER DDS
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5915 WEST STATE ROAD 46
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City | ELLETTSVILLE
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State | IN
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Zip | 47429
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Country | US
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Telephone | 812-876-7330
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Fax | 812-876-7325
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Provider Business Mailing Address
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Address Line | 5300 W BROOKWOOD CT
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City | BLOOMINGTON
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State | IN
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Zip | 47404-9601
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Country | US
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Telephone | 812-345-7117
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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 | 12010793A
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License Number State | IN
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