Provider Demographics
NPI:1730461559
Name:STEPHENVILLE FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:STEPHENVILLE FAMILY DENTISTRY, INC.
Other - Org Name:STEPHENVILLE FAMILY DENTISTRY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STANPHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-968-4433
Mailing Address - Street 1:2541 NORTHWEST LOOP
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1601
Mailing Address - Country:US
Mailing Address - Phone:254-968-4433
Mailing Address - Fax:254-968-3444
Practice Address - Street 1:2541 NORTHWEST LOOP
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401
Practice Address - Country:US
Practice Address - Phone:254-968-4433
Practice Address - Fax:254-968-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty