Healthcare Provider Details

I. General information

NPI: 1770499212
Provider Name (Legal Business Name): DR. MACKENZIE STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 LINCOLN PL
LYNBROOK NY
11563-3431
US

IV. Provider business mailing address

732 S BAYVIEW AVE
FREEPORT NY
11520-6047
US

V. Phone/Fax

Practice location:
  • Phone: 516-837-9283
  • Fax:
Mailing address:
  • Phone: 516-477-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI03050900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: