Provider Demographics
NPI:1568473833
Name:EDELSTEIN, STUART (DDS)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:EDELSTEIN
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 1:55 OLD TURNPIKE RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954
Mailing Address - Country:US
Mailing Address - Phone:845-623-2929
Mailing Address - Fax:
Practice Address - Street 1:55 OLD TURNPIKE RD
Practice Address - Street 2:SUITE 501
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:845-623-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist