Provider Demographics
NPI:1477595981
Name:STIEN, JEROME ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ALAN
Last Name:STIEN
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 1:1268 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-667-2279
Mailing Address - Fax:860-667-7713
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-667-2279
Practice Address - Fax:860-667-7713
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist