Provider Demographics
NPI:1194855106
Name:PIETRO, STEPHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:PIETRO
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 1:14651 PALM BEACH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2331
Mailing Address - Country:US
Mailing Address - Phone:239-694-9993
Mailing Address - Fax:239-561-9996
Practice Address - Street 1:201 PLAZA DR STE 1
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6071
Practice Address - Country:US
Practice Address - Phone:239-303-2400
Practice Address - Fax:239-303-2415
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015501122300000X
FLDN14213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist