Provider Demographics
NPI:1952451171
Name:STEPHENS, DOUGLAS KINDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KINDER
Last Name:STEPHENS
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 1:79 CANON RIDGE
Mailing Address - Street 2:
Mailing Address - City:FT. THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2059
Mailing Address - Country:US
Mailing Address - Phone:859-781-3638
Mailing Address - Fax:
Practice Address - Street 1:6405 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5221
Practice Address - Country:US
Practice Address - Phone:513-729-7994
Practice Address - Fax:913-752-9116
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60056900Medicaid