Provider Demographics
NPI:1043485154
Name:VICKERS, STEPHEN LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:VICKERS
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 1:13810 CHAMPION FOREST DR STE 204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-1868
Mailing Address - Country:US
Mailing Address - Phone:281-440-1200
Mailing Address - Fax:281-440-3578
Practice Address - Street 1:13810 CHAMPION FOREST DR STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-1868
Practice Address - Country:US
Practice Address - Phone:281-440-1200
Practice Address - Fax:281-440-3578
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist