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NPI Code Detail

MEDICARE: DR. STEPHEN LEWIS PRIFTAKIS DMD

MEDICARE: DR. STEPHEN LEWIS PRIFTAKIS DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist5811AZ
21223G0001XGeneral Practice DentistryDD5627NM

General Provider Information

NPI Number : 1780688176
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN LEWIS PRIFTAKIS DMD
Provider Business Mailing Address
First Line : 1625 W INA RD STE 109
Second Line :
City : TUCSON
State : AZ
Zip : 85704-1975
Country : US
Telephone Number : 520-275-0634
Fax Number :
Provider Business Practice Location Address
First Line : 1007 N POPE ST
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-5161
Country : US
Telephone Number : 575-388-1511
Fax Number : 575-313-8236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 07/13/2022

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