Provider Demographics
NPI:1124819032
Name:KELLEHER, STEPHEN (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:KELLEHER
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4441
Mailing Address - Country:US
Mailing Address - Phone:201-216-9191
Mailing Address - Fax:
Practice Address - Street 1:312 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4441
Practice Address - Country:US
Practice Address - Phone:201-216-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029354001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics