MEDICARE: DR. STEPHEN SPENCER WOOTEN 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	1223G0001X	General Practice Dentistry	1774-77	MS

General Provider Information

NPI Number	:	1295741247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN SPENCER WOOTEN DDS

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655-0158
Country	:	US
Telephone Number	:	662-801-6878
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	:	882-258-2461
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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