Provider Demographics
NPI:1639914963
Name:ZUNIGA BERNABE, STEPHANIA MICHELLE (DMD)
Entity type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:MICHELLE
Last Name:ZUNIGA BERNABE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ARTHO LN
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1131
Mailing Address - Country:US
Mailing Address - Phone:201-815-3401
Mailing Address - Fax:
Practice Address - Street 1:1050 MANTUA PIKE STE 201
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1141
Practice Address - Country:US
Practice Address - Phone:856-880-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIB30391001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice