Stephen Blaine Sines, DDS
Individual provider Active NPI General Practice Dentistry · Midland, MD
NPI 1053479477 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1053479477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6599 (MD)
- Practice address
- 19819 Broad Street
Midland, MD 21542-0335 - Phone
- (301) 463-6669
- Fax
- (301) 463-6336
- NPI assigned
- Dec 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6599 | MD | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6599 | MD | Yes |
Addresses
Primary practice location
19819 Broad Street
Midland, MD 21542-0335
Mailing address
19819 Broad Street
P.O.Box 335
Midland, MD 21542-0335
Phone (301) 463-6669
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0093569032 | Other | MD | EMPLOYER ID NUMBER |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.