Provider Demographics
NPI:1619080694
Name:STEPHENS, RHONDA AMELIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:AMELIA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 34TH ST
Mailing Address - Street 2:RAPHAEL HEALTH CENTER
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3754
Mailing Address - Country:US
Mailing Address - Phone:317-860-3993
Mailing Address - Fax:317-860-3971
Practice Address - Street 1:401 E 34TH ST
Practice Address - Street 2:RAPHAEL HEALTH CENTER
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3754
Practice Address - Country:US
Practice Address - Phone:317-860-3993
Practice Address - Fax:317-860-3971
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010764A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2005228308Medicaid
IN2005228308Medicaid
INV06076Medicare UPIN