Provider Demographics
NPI:1407978141
Name:CANDELORA, STEPHEN ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:CANDELORA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GRUBB ROAD
Mailing Address - Street 2:BRANDYWOOD PLAZA SUITE 132
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4799
Mailing Address - Country:US
Mailing Address - Phone:302-475-8181
Mailing Address - Fax:302-475-8185
Practice Address - Street 1:2500 GRUBB ROAD
Practice Address - Street 2:BRANDYWOOD PLAZA SUITE 132
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4799
Practice Address - Country:US
Practice Address - Phone:302-475-8181
Practice Address - Fax:302-475-8185
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDE9771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics