Provider Demographics
NPI:1104995521
Name:GAMERMAN, STEPHEN HAROLD (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HAROLD
Last Name:GAMERMAN
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:PO BOX 65028
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-0028
Mailing Address - Country:US
Mailing Address - Phone:410-539-1155
Mailing Address - Fax:410-685-5108
Practice Address - Street 1:107 W SARATOGA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3508
Practice Address - Country:US
Practice Address - Phone:410-539-1155
Practice Address - Fax:410-685-5108
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD78841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice