Healthcare Provider Details

I. General information

NPI: 1629125711
Provider Name (Legal Business Name): STEPHEN X SOLFANELLI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 PENN AVE
SCRANTON PA
18503-1921
US

IV. Provider business mailing address

243 PENN AVE
SCRANTON PA
18503-1921
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-2033
  • Fax: 570-346-2034
Mailing address:
  • Phone: 570-346-2033
  • Fax: 570-346-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS020138L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0008598160001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: