Provider Demographics
NPI:1447691654
Name:CHILDS, STEPHANIE (DMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BLOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:601 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2633 ROUTE 940
Practice Address - Street 2:
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346
Practice Address - Country:US
Practice Address - Phone:570-972-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0394961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice