Provider Demographics
NPI:1588785596
Name:ZOBRIST, STEPHEN M (DDS)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:ZOBRIST
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 1:6943 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8110
Mailing Address - Country:US
Mailing Address - Phone:225-248-6777
Mailing Address - Fax:225-927-6667
Practice Address - Street 1:802 W. RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666
Practice Address - Country:US
Practice Address - Phone:601-276-6330
Practice Address - Fax:601-276-2556
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS33171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02770819Medicaid
MN02770819Medicaid