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General NPI Number Information
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NPI Number | 1720411143
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Entity Type | Organization
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Legal Business Name | DR STEPHEN S PHELAN DMD PA
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 1554 E TRINITY BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-3609
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Country | US
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Telephone | 334-277-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 1554 E TRINITY BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-3609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | LYNDA KISSEL
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Credential |
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Telephone | 334-277-2100
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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 | 2873
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License Number State | AL
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