1689160160 NPI number — DR. STEPHANIE JEAN LENES GEORGE DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689160160 NPI number — DR. STEPHANIE JEAN LENES GEORGE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
STEPHANIE
Provider Middle Name:
JEAN LENES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LENES
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689160160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9905 CALVIN HALL RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
INDIAN LAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-650-3033
Provider Business Mailing Address Fax Number:
803-650-3035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9905 CALVIN HALL RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
INDIAN LAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-650-3033
Provider Business Practice Location Address Fax Number:
803-650-3035
Provider Enumeration Date:
07/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  9172 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: SC9172 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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