Provider Demographics
NPI:1780688176
Name:PRIFTAKIS, STEPHEN LEWIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:PRIFTAKIS
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 1:1625 W INA RD STE 109
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1975
Mailing Address - Country:US
Mailing Address - Phone:520-275-0634
Mailing Address - Fax:
Practice Address - Street 1:1007 N POPE ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5161
Practice Address - Country:US
Practice Address - Phone:575-388-1511
Practice Address - Fax:575-313-8236
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5811122300000X
NMDD56271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist