Provider Demographics
NPI:1316989411
Name:STEPHENS, JULIUS A (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:A
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3067
Mailing Address - Country:US
Mailing Address - Phone:803-279-6743
Mailing Address - Fax:803-279-9956
Practice Address - Street 1:1604 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3067
Practice Address - Country:US
Practice Address - Phone:803-279-6743
Practice Address - Fax:803-279-9956
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20611223G0001X
GA88251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8825Medicaid
SC2061Medicaid