Individual
DR. STEFAN SHANE HACKER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1015 W WASHBOURNE ST, JAY, OK 74346-4205
(918) 253-8696
Mailing address
200 E 3RD ST, GROVE, OK 74344-7006
(918) 787-7900
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5354
OK
Other
Enumeration date
10/20/2005
Last updated
05/19/2016
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