Provider Demographics
NPI:1629125711
Name:SOLFANELLI, STEPHEN X (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:X
Last Name:SOLFANELLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1921
Mailing Address - Country:US
Mailing Address - Phone:570-346-2033
Mailing Address - Fax:570-346-2034
Practice Address - Street 1:243 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1921
Practice Address - Country:US
Practice Address - Phone:570-346-2033
Practice Address - Fax:570-346-2034
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020138L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008598160001Medicaid
PAT28390Medicare UPIN
PA0008598160001Medicaid