Provider Demographics
NPI:1417964099
Name:DEAL, STEPHEN A (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:DEAL
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 1:17 WILSON FARM RD
Mailing Address - Street 2:P.O BOX 310
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9310
Mailing Address - Country:US
Mailing Address - Phone:501-679-4700
Mailing Address - Fax:501-679-4777
Practice Address - Street 1:17 WILSON FARM RD
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9310
Practice Address - Country:US
Practice Address - Phone:501-679-4700
Practice Address - Fax:501-679-4777
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist