MEDICARE: THE DENTAL CENTER OF NACOGDOCHES

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	19091	TX

General Provider Information

NPI Number	:	1821106428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DENTAL CENTER OF NACOGDOCHES

Provider Business Mailing Address
First Line	:	4703 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1607
Country	:	US
Telephone Number	:	936-560-0698
Fax Number	:

Provider Business Practice Location Address
First Line	:	4703 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1607
Country	:	US
Telephone Number	:	936-560-0698
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRENT A STEPHENS
Credential	:	D.D.S.
Telephone Number	:	936-560-0698

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/24/2008

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Directions to “THE DENTAL CENTER OF NACOGDOCHES ” Practice Location

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