Provider Demographics
NPI:1124287636
Name:DEXTER, STEPHEN ROOD
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROOD
Last Name:DEXTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 W HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1824
Mailing Address - Country:US
Mailing Address - Phone:281-667-6545
Mailing Address - Fax:
Practice Address - Street 1:5750 W THUNDERBIRD RD STE F600
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4667
Practice Address - Country:US
Practice Address - Phone:602-863-4203
Practice Address - Fax:602-863-4216
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA357237600000X
237700000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ310491Medicaid
AZZ196459OtherMEDICARE