Provider Demographics
NPI:1740499052
Name:BOONE, STEPHEN ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROBERT
Last Name:BOONE
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 1:85 SPRING ST STE 301
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3113
Mailing Address - Country:US
Mailing Address - Phone:603-524-8211
Mailing Address - Fax:603-524-3986
Practice Address - Street 1:85 SPRING ST STE 301
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3113
Practice Address - Country:US
Practice Address - Phone:603-524-8211
Practice Address - Fax:603-524-3986
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0504461223P0300X
NH039671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics