Provider Demographics
NPI:1558587956
Name:STEPHEN B MASTELLA,DMD &ASSOCIATES, PA
Entity Type:Organization
Organization Name:STEPHEN B MASTELLA,DMD &ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MASTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-685-2850
Mailing Address - Street 1:1030 N CHARLES ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5402
Mailing Address - Country:US
Mailing Address - Phone:410-685-2850
Mailing Address - Fax:410-685-4086
Practice Address - Street 1:1030 N CHARLES ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5402
Practice Address - Country:US
Practice Address - Phone:410-685-2850
Practice Address - Fax:410-685-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty