Provider Demographics
NPI:1083094528
Name:TANGREDI, STEPHEN JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:TANGREDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1811
Mailing Address - Country:US
Mailing Address - Phone:516-810-7753
Mailing Address - Fax:
Practice Address - Street 1:82 COYLE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1628
Practice Address - Country:US
Practice Address - Phone:207-772-7431
Practice Address - Fax:207-772-7477
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02584900122300000X
MEDEN4426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist