MEDICARE: DR. STEPHEN LEE VICKERS D.D.S.

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	122300000X	Dentist	16316	TX

General Provider Information

NPI Number	:	1043485154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN LEE VICKERS D.D.S.

Provider Business Mailing Address
First Line	:	13810 CHAMPION FOREST DR STE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1868
Country	:	US
Telephone Number	:	281-440-1200
Fax Number	:	281-440-3578

Provider Business Practice Location Address
First Line	:	13810 CHAMPION FOREST DR STE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1868
Country	:	US
Telephone Number	:	281-440-1200
Fax Number	:	281-440-3578

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	07/07/2010

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