Provider Demographics
NPI:1467507368
Name:DEXTER, STEPHANIE K (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:DEXTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 STATE ROAD 415
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4723
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-330-5074
Practice Address - Street 1:11881A EAST COLONIAL DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4723
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-330-5074
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 17526OtherDENTIST LICENSE