Provider Demographics
NPI:1013638022
Name:JOHN, STEPHIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHIN
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 IVY FARM CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8806
Mailing Address - Country:US
Mailing Address - Phone:770-597-3982
Mailing Address - Fax:
Practice Address - Street 1:3687 BUFORD DR # 300
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-5585
Practice Address - Country:US
Practice Address - Phone:470-317-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1228871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty