Provider Demographics
NPI:1467570440
Name:WEISGLASS, STEPHEN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:S
Last Name:WEISGLASS
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 1:11020 71ST RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4945
Mailing Address - Country:US
Mailing Address - Phone:718-544-8787
Mailing Address - Fax:718-268-9220
Practice Address - Street 1:11020 71ST RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4945
Practice Address - Country:US
Practice Address - Phone:718-544-8787
Practice Address - Fax:718-268-9220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038398-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics