Provider Demographics
NPI:1457550212
Name:TEPER, STUART (DDS)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:TEPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WAYNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4917
Mailing Address - Country:US
Mailing Address - Phone:516-822-2158
Mailing Address - Fax:516-822-2158
Practice Address - Street 1:25 WAYNE DRIVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4917
Practice Address - Country:US
Practice Address - Phone:516-822-2158
Practice Address - Fax:516-822-2158
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY386361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02 496 239Medicaid