Individual
DR. GLEN K STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
7480 NORTHVIEW ST, BOISE, ID 83704-7232
(208) 375-4041
(208) 375-0225
Mailing address
7480 NORTHVIEW ST, BOISE, ID 83704-7232
(208) 375-4041
(208) 375-0225
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3338
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051747
—
ID
Enumeration date
06/28/2006
Last updated
07/09/2007
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