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NPI Code Detail

MEDICARE: DR. JACK STEPHENS DDS

MEDICARE:  DR. JACK  STEPHENS  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
1122300000XDentist14370TX

General Provider Information

NPI Number : 1366607772
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK STEPHENS DDS
Provider Business Mailing Address
First Line : 6315 CYPRESSWOOD DR
Second Line :
City : SPRING
State : TX
Zip : 77379-8208
Country : US
Telephone Number : 281-320-2000
Fax Number : 281-320-0088
Provider Business Practice Location Address
First Line : 6315 CYPRESSWOOD DR
Second Line :
City : SPRING
State : TX
Zip : 77379-8208
Country : US
Telephone Number : 281-320-2000
Fax Number : 281-320-0088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2008
Last Update Date : 07/24/2008

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Directions to “ DR. JACK STEPHENS DDS” Practice Location

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