Provider Demographics
NPI:1386839793
Name:DAITCH, STUART LAWRENCE (DMD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:LAWRENCE
Last Name:DAITCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 50TH ST
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6817
Mailing Address - Country:US
Mailing Address - Phone:212-399-1155
Mailing Address - Fax:212-399-3233
Practice Address - Street 1:18 E 50TH ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6817
Practice Address - Country:US
Practice Address - Phone:212-399-1155
Practice Address - Fax:212-399-3233
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0438341223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics