Healthcare Provider Details

I. General information

NPI: 1689643447
Provider Name (Legal Business Name): STEVEN CIPRIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E RIDGEWOOD AVE
RIDGEWOOD NJ
07450-3956
US

IV. Provider business mailing address

834 LORETTA DR
RIVERVALE NJ
07675-6510
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-5588
  • Fax: 201-573-8499
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number22DI00991100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: