Provider Demographics
NPI:1558402636
Name:HOUGHTALING, STEPHEN W (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:HOUGHTALING
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 1:1785 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3508
Mailing Address - Country:US
Mailing Address - Phone:503-325-1470
Mailing Address - Fax:
Practice Address - Street 1:1785 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3508
Practice Address - Country:US
Practice Address - Phone:503-325-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice