Provider Demographics
NPI:1932195674
Name:PHELAN, STEPHEN STRATFORD (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:STRATFORD
Last Name:PHELAN
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 1:1554 E TRINITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3609
Mailing Address - Country:US
Mailing Address - Phone:334-277-2100
Mailing Address - Fax:334-277-2101
Practice Address - Street 1:1554 E TRINITY BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3609
Practice Address - Country:US
Practice Address - Phone:334-277-2100
Practice Address - Fax:334-277-2101
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics