Provider Demographics
NPI:1083736805
Name:TITENSOR, STEVEN WAYNE (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:TITENSOR
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 1:474 WALES CT
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5141
Mailing Address - Country:US
Mailing Address - Phone:972-462-0270
Mailing Address - Fax:
Practice Address - Street 1:1901 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 320
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4220
Practice Address - Country:US
Practice Address - Phone:972-355-9545
Practice Address - Fax:972-355-9544
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice