Provider Demographics
NPI:1023456399
Name:SVOBODA, STEPHANIE (DDS)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30180 ROAD D
Mailing Address - Street 2:
Mailing Address - City:GLENVIL
Mailing Address - State:NE
Mailing Address - Zip Code:68941-2747
Mailing Address - Country:US
Mailing Address - Phone:402-760-0290
Mailing Address - Fax:
Practice Address - Street 1:136 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1730
Practice Address - Country:US
Practice Address - Phone:402-879-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist