Provider Demographics
NPI:1649679085
Name:STEPHENS, WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:STEPHENS
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 1:808 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1398
Mailing Address - Country:US
Mailing Address - Phone:410-479-2650
Mailing Address - Fax:833-916-1012
Practice Address - Street 1:5607 NW 27TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-2826
Practice Address - Country:US
Practice Address - Phone:305-636-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05622511223P0221X
FLDN202051223P0221X
MD180181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry