Provider Demographics
NPI:1568462810
Name:DEMBITSKY, STEPHEN Z (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:Z
Last Name:DEMBITSKY
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 1:160 E 26TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3160
Mailing Address - Country:US
Mailing Address - Phone:970-625-2345
Mailing Address - Fax:970-625-9080
Practice Address - Street 1:160 E 26TH ST
Practice Address - Street 2:STE 1
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3160
Practice Address - Country:US
Practice Address - Phone:970-625-2345
Practice Address - Fax:970-625-9080
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26.43301.0000OtherCO ID
CO0204879Medicaid
CO0204879Medicaid