Provider Demographics
NPI:1255686440
Name:STEPHENS, STEPHANIE BERG (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BERG
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:CLAIRE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:100 E. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557
Mailing Address - Country:US
Mailing Address - Phone:717-354-5635
Mailing Address - Fax:717-354-4015
Practice Address - Street 1:100 E. MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557
Practice Address - Country:US
Practice Address - Phone:717-354-5635
Practice Address - Fax:717-354-4015
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039165122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist