Provider Demographics
NPI:1366472664
Name:STEPHENS, ROBERT JEFFERY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JEFFERY
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 SPRING MEADOWS WEST DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528
Mailing Address - Country:US
Mailing Address - Phone:419-865-7692
Mailing Address - Fax:419-865-9731
Practice Address - Street 1:7100 SPRING MEADOWS WEST DR.
Practice Address - Street 2:SUITE A
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528
Practice Address - Country:US
Practice Address - Phone:419-865-7692
Practice Address - Fax:419-865-9731
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics