Provider Demographics
NPI:1467894824
Name:STEPHENS, ELIJAH HOYT (DMD)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:HOYT
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CUMMING HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8071
Mailing Address - Country:US
Mailing Address - Phone:912-580-8511
Mailing Address - Fax:
Practice Address - Street 1:2020 CUMMING HWY STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8071
Practice Address - Country:US
Practice Address - Phone:912-580-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0159471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice