Provider Demographics
NPI:1073652848
Name:MACZUGA-STERN, GLORIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:MACZUGA-STERN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 KINGS HWY E
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-5400
Mailing Address - Country:US
Mailing Address - Phone:203-335-0020
Mailing Address - Fax:203-335-0030
Practice Address - Street 1:1100 KINGS HWY E
Practice Address - Street 2:SUITE 2E
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-5400
Practice Address - Country:US
Practice Address - Phone:203-335-0020
Practice Address - Fax:203-335-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist