Provider Demographics
NPI:1487821294
Name:STEIN, MITCHELL BARRY (DDS)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:BARRY
Last Name:STEIN
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:PO BOX 436
Mailing Address - Street 2:1 LOVELL ST
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589
Mailing Address - Country:US
Mailing Address - Phone:914-248-8725
Mailing Address - Fax:914-248-8461
Practice Address - Street 1:1 LOVELL ST
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589
Practice Address - Country:US
Practice Address - Phone:914-248-8725
Practice Address - Fax:914-248-8461
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist