Provider Demographics
NPI:1740329267
Name:AGENT, STEPHEN LEE (DMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:AGENT
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 1:308 E ARCADIA AVE
Mailing Address - Street 2:
Mailing Address - City:DAWSON SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42408-1636
Mailing Address - Country:US
Mailing Address - Phone:270-797-3319
Mailing Address - Fax:270-797-0516
Practice Address - Street 1:308 E ARCADIA AVE
Practice Address - Street 2:
Practice Address - City:DAWSON SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42408-1636
Practice Address - Country:US
Practice Address - Phone:270-797-3319
Practice Address - Fax:270-797-0516
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice