MEDICARE: DR. MICHAEL RICHARD STEPHENS JR. 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	5566	OK

General Provider Information

NPI Number	:	1376556142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RICHARD STEPHENS JR. DDS

Provider Business Mailing Address
First Line	:	8011 S SHERIDAN RD
Second Line	:	G
City	:	TULSA
State	:	OK
Zip	:	74133-8956
Country	:	US
Telephone Number	:	918-494-7055
Fax Number	:	918-494-8655

Provider Business Practice Location Address
First Line	:	8011 S SHERIDAN RD
Second Line	:	G
City	:	TULSA
State	:	OK
Zip	:	74133-8956
Country	:	US
Telephone Number	:	918-494-7055
Fax Number	:	918-494-8655

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/11/2013

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