Provider Demographics
NPI:1730182379
Name:STEMM, WILSON STEPHEN (DMD)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:STEPHEN
Last Name:STEMM
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 1:7800 ROGERS CAMPGROUND RD SE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:IN
Mailing Address - Zip Code:47117-9035
Mailing Address - Country:US
Mailing Address - Phone:812-969-3533
Mailing Address - Fax:812-968-9743
Practice Address - Street 1:7800 ROGERS CAMPGROUND RD SE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:IN
Practice Address - Zip Code:47117-9035
Practice Address - Country:US
Practice Address - Phone:812-969-3533
Practice Address - Fax:812-968-9743
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN80511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100115910AMedicaid