Healthcare Provider Details

I. General information

NPI: 1780688176
Provider Name (Legal Business Name): STEPHEN LEWIS PRIFTAKIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N POPE ST
SILVER CITY NM
88061-5161
US

IV. Provider business mailing address

1625 W INA RD STE 109
TUCSON AZ
85704-1975
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1511
  • Fax: 575-313-8236
Mailing address:
  • Phone: 520-275-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5811
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD5627
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: