MEDICARE: STEPHEN J. TSOUCARIS, DMD, PC

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
1	1223E0200X	Endodontics		NJ

General Provider Information

NPI Number	:	1932380151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN J. TSOUCARIS, DMD, PC

Provider Business Mailing Address
First Line	:	1323 ANDERSON AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-1771
Country	:	US
Telephone Number	:	201-969-0990
Fax Number	:	201-969-0660

Provider Business Practice Location Address
First Line	:	1323 ANDERSON AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-1771
Country	:	US
Telephone Number	:	201-969-0990
Fax Number	:	201-969-0660

Authorized Official
Title or Position	:	OWNER/ENDODONTIST
Name	:	DR. STEPHEN J TSOUCARIS
Credential	:	DMD
Telephone Number	:	201-969-0990

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	07/21/2022

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