Provider Demographics
NPI:1912981358
Name:GINSBERG, STEPHAN (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1341
Mailing Address - Country:US
Mailing Address - Phone:508-339-3766
Mailing Address - Fax:508-339-3767
Practice Address - Street 1:235 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1341
Practice Address - Country:US
Practice Address - Phone:508-339-3766
Practice Address - Fax:508-339-3767
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA135911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice