Provider Demographics
NPI:1689160160
Name:GEORGE, STEPHANIE JEAN LENES (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JEAN LENES
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:LENES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9905 CALVIN HALL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707
Mailing Address - Country:US
Mailing Address - Phone:803-650-3033
Mailing Address - Fax:803-650-3035
Practice Address - Street 1:9905 CALVIN HALL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707
Practice Address - Country:US
Practice Address - Phone:803-650-3033
Practice Address - Fax:803-650-3035
Is Sole Proprietor?:No
Enumeration Date:2018-07-08
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9172122300000X
SCSC91721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist