MEDICARE: DR. STEPHEN VICTOR WHITEKO D.M.D.

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	DS044155	PA
2	122300000X	Dentist	13827	NC

General Provider Information

NPI Number	:	1619743382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN VICTOR WHITEKO D.M.D.

Provider Business Mailing Address
First Line	:	2901 CASSIDY RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79916-3502
Country	:	US
Telephone Number	:	570-205-5308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER FORT B
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-3502
Country	:	US
Telephone Number	:	570-205-5308
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	10/11/2024

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