Provider Demographics
NPI:1841307048
Name:LINCOLN, STEPHEN RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RAY
Last Name:LINCOLN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 ASH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5232
Mailing Address - Country:US
Mailing Address - Phone:208-734-3148
Mailing Address - Fax:208-736-3907
Practice Address - Street 1:174 ASH STREET NORTH
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5232
Practice Address - Country:US
Practice Address - Phone:208-734-3148
Practice Address - Fax:208-736-3907
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist