Provider Demographics
NPI:1336207604
Name:BOOKMYER, STEPHEN BRADLEY (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRADLEY
Last Name:BOOKMYER
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ROUND ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4010
Mailing Address - Country:US
Mailing Address - Phone:512-244-3855
Mailing Address - Fax:
Practice Address - Street 1:2100 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4010
Practice Address - Country:US
Practice Address - Phone:512-244-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185811223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology