Provider Demographics
NPI:1578652442
Name:EBNER, STEPHEN MATTHEW (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:EBNER
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:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-1249
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-654-0481
Practice Address - Street 1:1800 MERCY DR FL 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-5646
Practice Address - Country:US
Practice Address - Phone:407-209-3304
Practice Address - Fax:407-209-3221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist