Provider Demographics
NPI:1265865075
Name:STEPHANICK, CAROL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:STEPHANICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S WHITE HORSE PIKE
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2029
Mailing Address - Country:US
Mailing Address - Phone:609-561-1500
Mailing Address - Fax:
Practice Address - Street 1:777 S WHITE HORSE PIKE
Practice Address - Street 2:SUITE C-2
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2029
Practice Address - Country:US
Practice Address - Phone:609-561-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0146911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice