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General NPI Number Information
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NPI Number | 1639707763
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Entity Type | Individual
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Provider Name | MARISSA STEIN
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 135 SULLYS TRL STE 1
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City | PITTSFORD
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State | NY
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Zip | 14534-4564
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Country | US
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Telephone | 585-218-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 1227 LAKE POINT DR
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City | WEBSTER
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State | NY
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Zip | 14580-9585
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Country | US
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Telephone | 585-451-8445
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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 | 061829
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License Number State | NY
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