MEDICARE: DR. STEPHEN ANDREW TRAGER 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	12010793A	IN

General Provider Information

NPI Number	:	1669555454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ANDREW TRAGER DDS

Provider Business Mailing Address
First Line	:	5300 W BROOKWOOD CT
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47404-9601
Country	:	US
Telephone Number	:	812-345-7117
Fax Number	:

Provider Business Practice Location Address
First Line	:	5915 WEST STATE ROAD 46
Second Line	:
City	:	ELLETTSVILLE
State	:	IN
Zip	:	47429
Country	:	US
Telephone Number	:	812-876-7330
Fax Number	:	812-876-7325

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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