Healthcare Provider Details

I. General information

NPI: 1669746533
Provider Name (Legal Business Name): EDWARD S. STIEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 65TH ST
BROOKLYN NY
11204-4170
US

IV. Provider business mailing address

2469 65TH ST
BROOKLYN NY
11204-4170
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-1122
  • Fax: 718-339-3504
Mailing address:
  • Phone: 718-339-1122
  • Fax: 718-339-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number036040-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: