Provider Demographics
NPI:1710459755
Name:STEPHENS & BURRELL FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:STEPHENS & BURRELL FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-465-3400
Mailing Address - Street 1:5370 STONE MOUNTAIN HWY STE 720
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3574
Mailing Address - Country:US
Mailing Address - Phone:770-465-3400
Mailing Address - Fax:
Practice Address - Street 1:5370 STONE MOUNTAIN HWY STE 720
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3574
Practice Address - Country:US
Practice Address - Phone:770-465-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty