Provider Demographics
NPI:1760045066
Name:POU, STEPHEN MIGUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MIGUEL
Last Name:POU
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 1:2150 BLACK ROCK TPKE STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3239
Mailing Address - Country:US
Mailing Address - Phone:203-333-2060
Mailing Address - Fax:203-333-0027
Practice Address - Street 1:2150 BLACK ROCK TPKE STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825
Practice Address - Country:US
Practice Address - Phone:203-333-2060
Practice Address - Fax:203-333-0027
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist