Provider Demographics
NPI:1063252427
Name:HLIS, STEPHEN JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:HLIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 CHESTER AVE APT 1613
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-0218
Mailing Address - Country:US
Mailing Address - Phone:325-998-4967
Mailing Address - Fax:
Practice Address - Street 1:2817 LOOP 250 FRONTAGE RD
Practice Address - Street 2:STE B
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705
Practice Address - Country:US
Practice Address - Phone:432-694-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice