Provider Demographics
NPI:1134133366
Name:FISCHTHAL, STEVEN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:FISCHTHAL
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 1:11 HANOVER SQ
Mailing Address - Street 2:STE. 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2818
Mailing Address - Country:US
Mailing Address - Phone:212-344-1007
Mailing Address - Fax:
Practice Address - Street 1:11 HANOVER SQ
Practice Address - Street 2:STE. 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2818
Practice Address - Country:US
Practice Address - Phone:212-344-1007
Practice Address - Fax:212-344-1009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-0289371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice