Provider Demographics
NPI:1528125655
Name:ROOT, STEPHEN H (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:ROOT
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 1:85 POST OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1247
Mailing Address - Country:US
Mailing Address - Phone:413-596-3881
Mailing Address - Fax:413-596-3883
Practice Address - Street 1:85 POST OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1247
Practice Address - Country:US
Practice Address - Phone:413-596-3881
Practice Address - Fax:413-596-3883
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice