Provider Demographics
NPI:1316656044
Name:GABOR, STEPHANIE ELAINE (RDH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:GABOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELAINE
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1280 LEASIDE LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3072
Mailing Address - Country:US
Mailing Address - Phone:423-715-3592
Mailing Address - Fax:423-321-8775
Practice Address - Street 1:4618 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-3013
Practice Address - Country:US
Practice Address - Phone:423-894-5725
Practice Address - Fax:423-321-8775
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3744124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist