Provider Demographics
NPI:1770501389
Name:STEPHENS, GREG L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5601
Mailing Address - Country:US
Mailing Address - Phone:831-636-5391
Mailing Address - Fax:831-636-9694
Practice Address - Street 1:893 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5601
Practice Address - Country:US
Practice Address - Phone:831-636-5391
Practice Address - Fax:831-636-9694
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice