MEDICARE: STEPHENS AND GATEWOOD 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	1223G0001X	General Practice Dentistry	18848	TX
2	1223G0001X	General Practice Dentistry	14370	TX

General Provider Information

NPI Number	:	1730220633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHENS AND GATEWOOD 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	:	INSURANCE COORDINATOR
Name	:	MRS. KIMBERLY DEANN SWANN
Credential	:
Telephone Number	:	281-320-2000

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/22/2020

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