Provider Demographics
NPI:1518949601
Name:STEPHAN, ERIC RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RICHARD
Last Name:STEPHAN
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 1:5201 OLYMPIC DR NW
Mailing Address - Street 2:SUITE 270
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1763
Mailing Address - Country:US
Mailing Address - Phone:253-853-7354
Mailing Address - Fax:253-853-7359
Practice Address - Street 1:5201 OLYMPIC DR NW
Practice Address - Street 2:SUITE 270
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1763
Practice Address - Country:US
Practice Address - Phone:253-853-7354
Practice Address - Fax:253-853-7359
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA54911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice