Provider Demographics
NPI:1659391316
Name:ST LOUIS, STEPHEN CHRISTOPHER (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHRISTOPHER
Last Name:ST LOUIS
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 LEGATO RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-4004
Mailing Address - Country:US
Mailing Address - Phone:703-385-7177
Mailing Address - Fax:703-385-2971
Practice Address - Street 1:4001 LEGATO RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4004
Practice Address - Country:US
Practice Address - Phone:703-385-7177
Practice Address - Fax:703-385-2971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA70981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice