Provider Demographics
NPI:1518034040
Name:SOKOLOFF, STEPHEN MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARK
Last Name:SOKOLOFF
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 1:760 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2230
Mailing Address - Country:US
Mailing Address - Phone:631-878-9300
Mailing Address - Fax:631-878-9316
Practice Address - Street 1:760 MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2230
Practice Address - Country:US
Practice Address - Phone:631-878-9300
Practice Address - Fax:631-878-9316
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0378781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112980154OtherTAX I.D.
NYU44358Medicare UPIN
NY112980154OtherTAX I.D.