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NPI Code Detail

MEDICARE: DR. BILLIE STEPHENS D.D.S.

MEDICARE: DR. BILLIE STEPHENS 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
11223G0001XGeneral Practice Dentistry3489TN

General Provider Information

NPI Number : 1164412920
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BILLIE STEPHENS D.D.S.
Provider Business Mailing Address
First Line : 140 DAMERON AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37917-6413
Country : US
Telephone Number : 865-215-5110
Fax Number : 865-215-5117
Provider Business Practice Location Address
First Line : 140 DAMERON AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37917-6413
Country : US
Telephone Number : 865-215-5110
Fax Number : 865-215-5117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 07/08/2007

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