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General NPI Number Information
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NPI Number | 1780688176
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Entity Type | Individual
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Provider Name | STEPHEN LEWIS PRIFTAKIS DMD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 1007 N POPE ST
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City | SILVER CITY
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State | NM
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Zip | 88061-5161
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Country | US
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Telephone | 575-388-1511
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Fax | 575-313-8236
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Provider Business Mailing Address
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Address Line | 1625 W INA RD STE 109
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City | TUCSON
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State | AZ
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Zip | 85704-1975
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Country | US
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Telephone | 520-275-0634
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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 | 5811
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD5627
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License Number State | NM
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