Provider Demographics
NPI:1669408134
Name:ST. JAMES, STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:ST. JAMES
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 1:200 W 72ND ST
Mailing Address - Street 2:17C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3194
Mailing Address - Country:US
Mailing Address - Phone:917-454-8121
Mailing Address - Fax:917-536-9744
Practice Address - Street 1:200 W 72ND ST
Practice Address - Street 2:17C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3194
Practice Address - Country:US
Practice Address - Phone:917-454-8121
Practice Address - Fax:917-536-9744
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0525681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics