Provider Demographics
NPI:1992728513
Name:OBROCHTA, STEPHEN P (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:OBROCHTA
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 1:4464 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1142
Mailing Address - Country:US
Mailing Address - Phone:727-321-4464
Mailing Address - Fax:727-323-3248
Practice Address - Street 1:4464 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1142
Practice Address - Country:US
Practice Address - Phone:727-321-4464
Practice Address - Fax:727-323-3248
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL66669OtherBC/BS PROVIDER #