Provider Demographics
NPI:1578670139
Name:SINCLAIR, STEPHEN GIRARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GIRARD
Last Name:SINCLAIR
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 510
Mailing Address - Street 2:MANCHIN CLINIC THIRD FLOOR
Mailing Address - City:FARMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26571-0510
Mailing Address - Country:US
Mailing Address - Phone:304-825-6004
Mailing Address - Fax:
Practice Address - Street 1:1021 MAIN ST
Practice Address - Street 2:MANCHIN CLINIC 3RD FLR
Practice Address - City:FARMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26571-0510
Practice Address - Country:US
Practice Address - Phone:304-825-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist