Provider Demographics
NPI:1821170671
Name:DEMYER, STEPHEN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:DEMYER
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 1:408 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1904
Mailing Address - Country:US
Mailing Address - Phone:201-747-7780
Mailing Address - Fax:
Practice Address - Street 1:924 ROUTE10
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-584-0008
Practice Address - Fax:973-584-5663
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ193531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice