Provider Demographics
NPI:1871765974
Name:SCHENK, STEPHEN FREDERICK (DDS, MS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FREDERICK
Last Name:SCHENK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8646
Mailing Address - Country:US
Mailing Address - Phone:208-375-9480
Mailing Address - Fax:208-375-6804
Practice Address - Street 1:1228 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8646
Practice Address - Country:US
Practice Address - Phone:208-375-9480
Practice Address - Fax:208-375-6804
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4242-PE1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics