Provider Demographics
NPI:1669519195
Name:REISFELD, STACY HOPE (DDS)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:HOPE
Last Name:REISFELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 JEFFREY LN
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1443
Mailing Address - Country:US
Mailing Address - Phone:631-288-9173
Mailing Address - Fax:
Practice Address - Street 1:335 TERRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5510
Practice Address - Country:US
Practice Address - Phone:631-724-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041693-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics