Healthcare Provider Details

I. General information

NPI: 1801851597
Provider Name (Legal Business Name): STEVEN SPERONI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MAIDEN LANE
PENN YAN NY
14527-1201
US

IV. Provider business mailing address

14 MAIDEN LN PO BOX 423
PENN YAN NY
14527-1208
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-2024
  • Fax: 315-536-4005
Mailing address:
  • Phone: 315-531-9102
  • Fax: 315-531-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number046-480
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: