Provider Demographics
NPI:1275070955
Name:GANTER, STEPHANIE RENEE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:RENEE
Last Name:GANTER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 N PRESIDENT GEORGE BUSH HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2742
Mailing Address - Country:US
Mailing Address - Phone:972-272-8571
Mailing Address - Fax:972-272-8572
Practice Address - Street 1:4880 N PRESIDENT GEORGE BUSH HWY STE 101
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2742
Practice Address - Country:US
Practice Address - Phone:972-272-8571
Practice Address - Fax:972-272-8572
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics