Healthcare Provider Details

I. General information

NPI: 1013531409
Provider Name (Legal Business Name): STEPHEN D KUPNIEWSKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 W 38TH ST
ERIE PA
16506-4564
US

IV. Provider business mailing address

2330 W 38TH ST
ERIE PA
16506-4564
US

V. Phone/Fax

Practice location:
  • Phone: 814-835-8300
  • Fax: 814-833-2890
Mailing address:
  • Phone: 814-835-8300
  • Fax: 814-833-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS042689
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: