Provider Demographics
NPI:1528286721
Name:JEROME A STIEN DDS PC
Entity type:Organization
Organization Name:JEROME A STIEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-667-2279
Mailing Address - Street 1:1268 MAIN ST
Mailing Address - Street 2:202
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3038
Mailing Address - Country:US
Mailing Address - Phone:860-667-2279
Mailing Address - Fax:860-667-7713
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:202
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3038
Practice Address - Country:US
Practice Address - Phone:860-667-2279
Practice Address - Fax:860-667-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty