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General NPI Number Information
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NPI Number | 1932195674
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Entity Type | Individual
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Provider Name | STEPHEN STRATFORD PHELAN DMD
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/20/2013
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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 | 334-277-2101
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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 | 334-277-2100
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Fax | 334-277-2101
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2873
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License Number State | AL
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