Provider Demographics
NPI:1013041425
Name:GANT, STEPHEN MICHEAL SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHEAL
Last Name:GANT
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CHARTER DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3629
Mailing Address - Country:US
Mailing Address - Phone:410-730-6702
Mailing Address - Fax:
Practice Address - Street 1:10700 CHARTER DR
Practice Address - Street 2:SUITE 340
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3629
Practice Address - Country:US
Practice Address - Phone:410-730-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist