Provider Demographics
NPI:1114550076
Name:KINGSLEY, STEFANIA BALASA (DDS)
Entity Type:Individual
Prefix:
First Name:STEFANIA
Middle Name:BALASA
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3648
Mailing Address - Country:US
Mailing Address - Phone:732-528-0600
Mailing Address - Fax:
Practice Address - Street 1:147 UNION AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3648
Practice Address - Country:US
Practice Address - Phone:732-528-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70961223G0001X
TX381091223G0001X
NJ22DI03018100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice