Provider Demographics
NPI:1396752085
Name:STEPHENSON, JOHN GEORGE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:STEPHENSON
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 1:7501 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2923
Mailing Address - Country:US
Mailing Address - Phone:703-256-4500
Mailing Address - Fax:703-256-1666
Practice Address - Street 1:7501 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2923
Practice Address - Country:US
Practice Address - Phone:703-256-4500
Practice Address - Fax:703-256-1666
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010051611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice