Provider Demographics
NPI:1568564706
Name:DALLOW, STEPHEN P (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:DALLOW
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 1:268 TINKER ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1129
Mailing Address - Country:US
Mailing Address - Phone:845-679-6083
Mailing Address - Fax:845-676-6158
Practice Address - Street 1:268 TINKER ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1129
Practice Address - Country:US
Practice Address - Phone:845-679-6083
Practice Address - Fax:845-676-6158
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist