Provider Demographics
NPI:1831148303
Name:KOVAR, STEPHEN A (DMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:KOVAR
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 1:81 W GUADALUPE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3321
Mailing Address - Country:US
Mailing Address - Phone:480-507-2922
Mailing Address - Fax:480-507-5575
Practice Address - Street 1:81 W GUADALUPE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3321
Practice Address - Country:US
Practice Address - Phone:480-507-2922
Practice Address - Fax:480-507-5575
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67521223G0001X
ORD71621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice