Provider Demographics
NPI:1073601969
Name:VESTER, STEPHEN DOUGLAS (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:VESTER
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BUCHER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3400
Mailing Address - Country:US
Mailing Address - Phone:870-425-7645
Mailing Address - Fax:870-425-9325
Practice Address - Street 1:250 BUCHER DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3400
Practice Address - Country:US
Practice Address - Phone:870-425-7645
Practice Address - Fax:870-425-9325
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
542296OtherUNITED CONCORDIA
2526OtherDELTA DENTAL
58797OtherBCBS