Provider Demographics
NPI:1689950412
Name:WILLIE L. STEPHENS, DDS, PC
Entity Type:Organization
Organization Name:WILLIE L. STEPHENS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-235-4554
Mailing Address - Street 1:372 WASHINGTON ST
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6202
Mailing Address - Country:US
Mailing Address - Phone:781-235-4554
Mailing Address - Fax:781-237-2947
Practice Address - Street 1:372 WASHINGTON ST
Practice Address - Street 2:SUITE 2500
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6202
Practice Address - Country:US
Practice Address - Phone:781-235-4554
Practice Address - Fax:781-237-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty