Provider Demographics
NPI:1063625861
Name:DAUTEL, STEPHEN P (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:DAUTEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6802
Mailing Address - Country:US
Mailing Address - Phone:518-371-1275
Mailing Address - Fax:518-371-1806
Practice Address - Street 1:1631 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-6802
Practice Address - Country:US
Practice Address - Phone:518-371-1275
Practice Address - Fax:518-371-1806
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist