Provider Demographics
NPI:1861499477
Name:WORLEY, STEVEN J (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:WORLEY
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 1:267 PANOLA DR
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-4219
Mailing Address - Country:US
Mailing Address - Phone:318-757-6391
Mailing Address - Fax:318-757-9370
Practice Address - Street 1:1810 EE WALLACE BLVD N
Practice Address - Street 2:#2 HUNTINGTON PLAZA
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2253
Practice Address - Country:US
Practice Address - Phone:318-757-3648
Practice Address - Fax:318-757-9370
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA973373OtherTRICARE PROVIDER #
LA1850691Medicaid