Provider Demographics
NPI:1952403511
Name:VALIS, STEPHEN SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SEAN
Last Name:VALIS
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 1:1144 INDIA HOOK RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2400
Mailing Address - Country:US
Mailing Address - Phone:803-328-3891
Mailing Address - Fax:303-328-2159
Practice Address - Street 1:1144 INDIA HOOK RD STE B
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2400
Practice Address - Country:US
Practice Address - Phone:803-328-3891
Practice Address - Fax:303-328-2159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist