Provider Demographics
NPI:1467604504
Name:KORSON, STEPHEN BARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BARRY
Last Name:KORSON
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 1:115 KENT PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4703
Mailing Address - Country:US
Mailing Address - Phone:908-522-0640
Mailing Address - Fax:908-522-6677
Practice Address - Street 1:115 KENT PLACE BLVD
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4703
Practice Address - Country:US
Practice Address - Phone:908-522-0640
Practice Address - Fax:908-522-6677
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011311001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI01131100OtherNEW JERSEY DENTAL LICENCE