MEDICARE: PATRICK H STEPHENS DMD PC

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	10572	GA

General Provider Information

NPI Number	:	1174608921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK H STEPHENS DMD PC

Provider Business Mailing Address
First Line	:	7 CARL MIDWAY CH RD
Second Line	:
City	:	AUBURN
State	:	GA
Zip	:	30011
Country	:	US
Telephone Number	:	770-867-6144
Fax Number	:	770-867-1904

Provider Business Practice Location Address
First Line	:	7 CARL MIDWAY CH RD
Second Line	:
City	:	AUBURN
State	:	GA
Zip	:	30011
Country	:	US
Telephone Number	:	770-867-6144
Fax Number	:	770-867-1904

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PATRICIA R STEPHENS
Credential	:
Telephone Number	:	770-867-6144

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	09/19/2007

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