Provider Demographics
NPI:1255412953
Name:DEMMI, STEPHEN B (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:DEMMI
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 1:437 SW PERIMETER GLEN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:386-961-9669
Mailing Address - Fax:386-752-3122
Practice Address - Street 1:437 SW PERIMETER GLEN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-961-9669
Practice Address - Fax:386-752-3122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00135441223G0001X
FLDN135441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice