Provider Demographics
NPI:1558347245
Name:YAMODIS, STEPHEN ALEXANDER (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALEXANDER
Last Name:YAMODIS
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:PSC BOX 20130
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0130
Mailing Address - Country:US
Mailing Address - Phone:910-451-2208
Mailing Address - Fax:910-451-8036
Practice Address - Street 1:2D DENTAL BATTALION
Practice Address - Street 2:NAVAL DENTAL CENTER
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:910-451-2208
Practice Address - Fax:910-451-2208
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS036724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist