Provider Demographics
NPI:1760601371
Name:TEOTIA, STEPHANIE KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KATHRYN
Last Name:TEOTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KATHRYN
Other - Last Name:BEIDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4231 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2691
Mailing Address - Country:US
Mailing Address - Phone:214-823-9652
Mailing Address - Fax:214-823-4935
Practice Address - Street 1:4231 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2691
Practice Address - Country:US
Practice Address - Phone:214-823-9652
Practice Address - Fax:214-823-4935
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01643208600000X
TXP21942086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery