Provider Demographics
NPI:1225003296
Name:DENTLER, STEPHEN MAX (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MAX
Last Name:DENTLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9410 NE ZAC LENTZ PKWY,
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3108
Mailing Address - Country:US
Mailing Address - Phone:361-579-1333
Mailing Address - Fax:361-579-1334
Practice Address - Street 1:9410 NE ZAC LENTZ PKWY,
Practice Address - Street 2:SUITE 202
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3108
Practice Address - Country:US
Practice Address - Phone:361-579-1333
Practice Address - Fax:361-579-1334
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG66361Medicare UPIN