Provider Demographics
NPI:1689160160
Name:GEORGE, STEPHANIE JEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JEAN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:LENES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2038 COUNTRY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7410
Mailing Address - Country:US
Mailing Address - Phone:843-670-9539
Mailing Address - Fax:
Practice Address - Street 1:3300 W MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-7916
Practice Address - Country:US
Practice Address - Phone:843-225-9506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist