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NPI Code Detail

MEDICARE: JONATHAN MICHAEL STEPHENS DDS

MEDICARE: JONATHAN MICHAEL 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
1122300000XDentist32743TX

General Provider Information

NPI Number : 1699207431
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN MICHAEL STEPHENS DDS
Provider Business Mailing Address
First Line : 505 E HUNTLAND DR STE 340
Second Line :
City : AUSTIN
State : TX
Zip : 78752-3745
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2700 S 1ST ST
Second Line :
City : AUSTIN
State : TX
Zip : 78704-5421
Country : US
Telephone Number : 512-442-4338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2017
Last Update Date : 03/31/2017

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Directions to “ JONATHAN MICHAEL STEPHENS DDS” Practice Location

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