Provider Demographics
NPI:1427484799
Name:FAVERO, STEPHEN B (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:FAVERO
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 1:3201 TEASLEY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8301
Mailing Address - Country:US
Mailing Address - Phone:940-566-2847
Mailing Address - Fax:
Practice Address - Street 1:3201 TEASLEY LN STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8301
Practice Address - Country:US
Practice Address - Phone:940-566-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63303122300000X
MO2013034508122300000X
TX382461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist