Provider Demographics
NPI:1831108349
Name:WOLPO, STEPHEN HARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HARRIS
Last Name:WOLPO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:H
Other - Last Name:WOLPO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:60 STRAWBERRY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:05902
Mailing Address - Country:US
Mailing Address - Phone:203-323-9277
Mailing Address - Fax:203-324-9633
Practice Address - Street 1:60 STRAWBERRY HILL AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:05902
Practice Address - Country:US
Practice Address - Phone:203-323-9277
Practice Address - Fax:203-324-9633
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040423122300000X
CT6952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2069525Medicaid
NY00986329Medicaid
CT2069525Medicaid