Provider Demographics
NPI:1013531409
Name:KUPNIEWSKI, STEPHEN D (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:KUPNIEWSKI
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 1:2330 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4564
Mailing Address - Country:US
Mailing Address - Phone:814-835-8300
Mailing Address - Fax:814-833-2890
Practice Address - Street 1:2330 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4564
Practice Address - Country:US
Practice Address - Phone:814-835-8300
Practice Address - Fax:814-833-2890
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist