Provider Demographics
NPI:1912331612
Name:STEPHEN FAMIY DENTISTRY
Entity Type:Organization
Organization Name:STEPHEN FAMIY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:XIAOFENG
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-586-0190
Mailing Address - Street 1:1 W ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1307
Mailing Address - Country:US
Mailing Address - Phone:610-586-0190
Mailing Address - Fax:610-586-9630
Practice Address - Street 1:1 W ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1307
Practice Address - Country:US
Practice Address - Phone:610-586-0190
Practice Address - Fax:610-586-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031393L302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization