Provider Demographics
NPI:1861509630
Name:DECASPERIS, STEVEN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAMES
Last Name:DECASPERIS
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 1:99 GRAYROCK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1076
Mailing Address - Country:US
Mailing Address - Phone:908-638-5242
Mailing Address - Fax:
Practice Address - Street 1:99 GRAYROCK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1076
Practice Address - Country:US
Practice Address - Phone:908-638-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01511400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist