Provider Demographics
NPI:1295741247
Name:WOOTEN, STEPHEN SPENCER (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SPENCER
Last Name:WOOTEN
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 158
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-0158
Mailing Address - Country:US
Mailing Address - Phone:662-801-6878
Mailing Address - Fax:
Practice Address - Street 1:202 MEADOWLANE ST
Practice Address - Street 2:
Practice Address - City:EUPORA
Practice Address - State:MS
Practice Address - Zip Code:39744-2219
Practice Address - Country:US
Practice Address - Phone:882-258-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1774-771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice