Provider Demographics
NPI:1801923123
Name:WHITLEY, STEPHANIE LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LEE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:LEE
Other - Last Name:COSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2 WEST DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1843
Mailing Address - Country:US
Mailing Address - Phone:636-777-7777
Mailing Address - Fax:636-777-4407
Practice Address - Street 1:2 WEST DR STE 100
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-1843
Practice Address - Country:US
Practice Address - Phone:636-777-7777
Practice Address - Fax:636-777-4407
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY79671223P0221X
MO20070275461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry