MEDICARE: STEPHEN S. WOOTEN DDS PA

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	1774-77	MS

General Provider Information

NPI Number	:	1023156999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN S. WOOTEN DDS PA

Provider Business Mailing Address
First Line	:	PO BOX 726
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-0726
Country	:	US
Telephone Number	:	662-258-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 MEADOWLANE ST
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2219
Country	:	US
Telephone Number	:	662-258-2461
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVE WOOTEN
Credential	:	DDS
Telephone Number	:	662-258-2461

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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