Provider Demographics
NPI:1639719099
Name:STEFANOU, ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:STEFANOU
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 1:116 W 23RD ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2599
Mailing Address - Country:US
Mailing Address - Phone:646-375-2067
Mailing Address - Fax:
Practice Address - Street 1:116 W 23RD ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2599
Practice Address - Country:US
Practice Address - Phone:646-375-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0410231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice