Provider Demographics
NPI:1588775431
Name:LADENHEIM, STEPHEN
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:LADENHEIM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:LADENHEIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-475-6274
Mailing Address - Fax:
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-475-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0362801223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics