Provider Demographics
NPI:1063008316
Name:GELVEN, STEFAN JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:JACOB
Last Name:GELVEN
Suffix:
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 1:4599 N WASHINGTON ST APT 33D
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-1350
Mailing Address - Country:US
Mailing Address - Phone:580-304-1800
Mailing Address - Fax:
Practice Address - Street 1:503 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4655
Practice Address - Country:US
Practice Address - Phone:580-200-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist