Individual
JOHN RUSSELL STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2601 E ELMS RD, KILLEEN, TX 76542-2804
(254) 699-4127
(254) 699-4130
Mailing address
2601 E ELMS RD, P.O. BOX 11022, KILLEEN, TX 76542-2804
(254) 699-4127
(254) 699-4130
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12910
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
689845
UNITED CONCORDIA
TX
01
—
D12910
BC/BS
TX
Enumeration date
07/17/2006
Last updated
07/08/2007
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