Provider Demographics
NPI:1629030846
Name:AWE, STEPHEN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:AWE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2410 STANLEY ROAD
Mailing Address - Street 2:DENTAC SUITE 200J
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6230
Mailing Address - Country:US
Mailing Address - Phone:210-295-2743
Mailing Address - Fax:210-295-2602
Practice Address - Street 1:2410 STANLEY ROAD
Practice Address - Street 2:DENTAC SUITE 200J
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6230
Practice Address - Country:US
Practice Address - Phone:210-295-2743
Practice Address - Fax:210-295-2602
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics