Provider Demographics
NPI:1659472512
Name:DEFUSCO, STEPHEN MICHEAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHEAL
Last Name:DEFUSCO
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 1:5154 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2256
Mailing Address - Country:US
Mailing Address - Phone:412-688-8446
Mailing Address - Fax:412-688-8447
Practice Address - Street 1:5154 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2256
Practice Address - Country:US
Practice Address - Phone:412-688-8446
Practice Address - Fax:412-688-8447
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024049-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADE 94531OtherB/S #