Provider Demographics
NPI:1295740975
Name:STEPHEN E. SCHALLER DMD PC
Entity type:Organization
Organization Name:STEPHEN E. SCHALLER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-589-5088
Mailing Address - Street 1:285 W MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2540
Mailing Address - Country:US
Mailing Address - Phone:631-589-5088
Mailing Address - Fax:
Practice Address - Street 1:285 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2540
Practice Address - Country:US
Practice Address - Phone:631-589-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty