Provider Demographics
NPI:1811916554
Name:LADUQUE, STEPHEN M (DDS PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:LADUQUE
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S MARY ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-4103
Mailing Address - Country:US
Mailing Address - Phone:254-965-2777
Mailing Address - Fax:254-965-3081
Practice Address - Street 1:132 S MARY ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-4103
Practice Address - Country:US
Practice Address - Phone:254-965-2777
Practice Address - Fax:254-965-3081
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice