Provider Demographics
NPI:1750634440
Name:DARMITZEL, STEPHEN E (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:DARMITZEL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 KIVA CT STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5878
Mailing Address - Country:US
Mailing Address - Phone:505-982-6656
Mailing Address - Fax:
Practice Address - Street 1:400 KIVA CT STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5878
Practice Address - Country:US
Practice Address - Phone:505-982-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD34901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics