Provider Demographics
NPI:1659486389
Name:STEPHENS, GEORGE MILBURN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MILBURN
Last Name:STEPHENS
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 1:10700 SE 174TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5472
Mailing Address - Country:US
Mailing Address - Phone:425-228-3420
Mailing Address - Fax:425-228-3773
Practice Address - Street 1:10700 SE 174TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5472
Practice Address - Country:US
Practice Address - Phone:425-228-3420
Practice Address - Fax:425-228-3773
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00003501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5307004Medicaid