Provider Demographics
NPI:1386768869
Name:MOONEY, STEPHEN PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:MOONEY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1736
Mailing Address - Country:US
Mailing Address - Phone:315-331-7127
Mailing Address - Fax:
Practice Address - Street 1:631 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1726
Practice Address - Country:US
Practice Address - Phone:315-331-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist