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General NPI Number Information
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NPI Number | 1619043528
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Entity Type | Individual
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Provider Name | STEPHEN JOHN MIKLETHUN DDS
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Gender | Male
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 3 PARKSIDE CT STE A
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City | UTICA
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State | NY
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Zip | 13501-5643
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Country | US
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Telephone | 315-927-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 578 NEWPORT ROAD
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City | UTICA
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State | NY
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Zip | 13502
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Country | US
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Telephone | 315-383-9636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0509171
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License Number State | NY
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