MEDICARE: DR. GREGORY STEPHANOS DDS

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	31364	TX

General Provider Information

NPI Number	:	1225404387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY STEPHANOS DDS

Provider Business Mailing Address
First Line	:	2234 NAOMI ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3824
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2234 NAOMI ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3824
Country	:	US
Telephone Number	:	713-992-8292
Fax Number	:

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

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	08/12/2015

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