Provider Demographics
NPI:1790193126
Name:COUPERUS, STEPHANIE STEELE (DDS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:STEELE
Last Name:COUPERUS
Suffix:
Gender:F
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:US ARMY DENTAC BLDG 9900 FL 2
Mailing Address - Street 2:LINCOLN ST.
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4029
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAC BLDG 9900 FL 2
Practice Address - Street 2:LINCOLN ST.
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012153A122300000X
WADE 60715475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist