Provider Demographics
NPI:1881796266
Name:STEFAN, MANUEL (DDS)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:STEFAN
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 1:4711 CURRY FORD RD
Mailing Address - Street 2:STE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812
Mailing Address - Country:US
Mailing Address - Phone:407-281-8700
Mailing Address - Fax:407-281-4983
Practice Address - Street 1:4711 CURRY FORD RD
Practice Address - Street 2:STE. A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2704
Practice Address - Country:US
Practice Address - Phone:407-281-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013180122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0700XDental ProvidersDentistProsthodontics