Provider Demographics
NPI:1942207543
Name:MACKLER, STEPHEN BARRY (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BARRY
Last Name:MACKLER
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E WENDOVER AVE
Mailing Address - Street 2:STE 315
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1231
Mailing Address - Country:US
Mailing Address - Phone:336-379-8377
Mailing Address - Fax:336-275-2078
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:STE 315
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1231
Practice Address - Country:US
Practice Address - Phone:336-379-8377
Practice Address - Fax:336-275-2078
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 33721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics