Provider Demographics
NPI:1780755314
Name:ENGLISH, STEPHEN CRAIG (DMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CRAIG
Last Name:ENGLISH
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 1:2363 2 DUNN AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4601
Mailing Address - Country:US
Mailing Address - Phone:904-751-3390
Mailing Address - Fax:904-751-3392
Practice Address - Street 1:2363 2 DUNN AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4601
Practice Address - Country:US
Practice Address - Phone:904-751-3390
Practice Address - Fax:904-751-3392
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9597204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T94264Medicare UPIN
60863Medicare ID - Type Unspecified