Provider Demographics
NPI:1821068958
Name:RADCLIFFE, STEPHEN SMITH (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SMITH
Last Name:RADCLIFFE
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:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:BURGESS
Mailing Address - State:VA
Mailing Address - Zip Code:22432-0628
Mailing Address - Country:US
Mailing Address - Phone:804-453-4361
Mailing Address - Fax:
Practice Address - Street 1:216 JESSIE DUPONT MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:BURGESS
Practice Address - State:VA
Practice Address - Zip Code:22432-0628
Practice Address - Country:US
Practice Address - Phone:804-453-4361
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401006554OtherSTATE LICENSE NUMBER