MEDICARE: DR. STEPHIN JOHN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN122887	GA

General Provider Information

NPI Number	:	1013638022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHIN JOHN DMD

Provider Business Mailing Address
First Line	:	3403 IVY FARM CT
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-8806
Country	:	US
Telephone Number	:	770-597-3982
Fax Number	:

Provider Business Practice Location Address
First Line	:	3687 BUFORD DR # 300
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-5585
Country	:	US
Telephone Number	:	470-317-2078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	09/07/2022

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