Provider Demographics
NPI:1417043050
Name:FUTRELL, STEPHEN CRAIG (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CRAIG
Last Name:FUTRELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:C
Other - Last Name:FUTRELL, DDS, PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:32 OFFICE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-353-8200
Mailing Address - Fax:910-353-2196
Practice Address - Street 1:32 OFFICE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-353-8200
Practice Address - Fax:910-353-2196
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC92984Medicaid