Provider Demographics
NPI:1376556142
Name:STEPHENS, MICHAEL RICHARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:STEPHENS
Suffix:JR
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 1:8011 S SHERIDAN RD
Mailing Address - Street 2:G
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8956
Mailing Address - Country:US
Mailing Address - Phone:918-494-7055
Mailing Address - Fax:918-494-8655
Practice Address - Street 1:8011 S SHERIDAN RD
Practice Address - Street 2:G
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-8956
Practice Address - Country:US
Practice Address - Phone:918-494-7055
Practice Address - Fax:918-494-8655
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist