Healthcare Provider Details

I. General information

NPI: 1285643940
Provider Name (Legal Business Name): STEPHEN O. HAND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N TIOGA ST
ITHACA NY
14850-4320
US

IV. Provider business mailing address

102 N TIOGA ST
ITHACA NY
14850-4320
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-8550
  • Fax: 607-275-0005
Mailing address:
  • Phone: 607-272-8550
  • Fax: 607-275-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number31084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: