Provider Demographics
NPI:1144328295
Name:STEPHENS, LINDA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARIE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 DREHERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-9603
Mailing Address - Country:US
Mailing Address - Phone:570-366-0744
Mailing Address - Fax:570-366-0744
Practice Address - Street 1:1700 S LINCOLN AVE
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7529
Practice Address - Country:US
Practice Address - Phone:717-272-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028309-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice