Provider Demographics
NPI:1609896349
Name:GULLINGS, STEPHEN DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DALE
Last Name:GULLINGS
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 1:205 E. 4TH AVE.
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2605
Mailing Address - Country:US
Mailing Address - Phone:605-996-2411
Mailing Address - Fax:605-996-2411
Practice Address - Street 1:205 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2605
Practice Address - Country:US
Practice Address - Phone:605-996-2411
Practice Address - Fax:605-996-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7803132Medicaid