Provider Demographics
NPI:1871936633
Name:GARRETT, STEPHANIE PHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:PHAN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:XUAN-TRANG
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2859 CARIBBEAN CV
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2763
Mailing Address - Country:US
Mailing Address - Phone:916-531-1952
Mailing Address - Fax:
Practice Address - Street 1:2859 CARIBBEAN CV
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2763
Practice Address - Country:US
Practice Address - Phone:916-531-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry