Provider Demographics
NPI:1730220633
Name:STEPHENS AND GATEWOOD DDS
Entity type:Organization
Organization Name:STEPHENS AND GATEWOOD DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-320-2000
Mailing Address - Street 1:6315 CYPRESSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8208
Mailing Address - Country:US
Mailing Address - Phone:281-320-2000
Mailing Address - Fax:281-320-0088
Practice Address - Street 1:6315 CYPRESSWOOD DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8208
Practice Address - Country:US
Practice Address - Phone:281-320-2000
Practice Address - Fax:281-320-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188481223G0001X
TX143701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty