Provider Demographics
NPI:1396838447
Name:WHITEHEAD, STEPHANIE BRYANT (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BRYANT
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 RIVERCHASE OFFICE PLAZA
Mailing Address - Street 2:STE 212
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-988-9678
Mailing Address - Fax:205-988-9065
Practice Address - Street 1:3 RIVERCHASE OFFICE PLAZA
Practice Address - Street 2:STE 212
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-988-9678
Practice Address - Fax:205-988-9065
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics