Provider Demographics
NPI:1699165696
Name:GAZDICK, STEPHEN (DDS, PC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GAZDICK
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-2511
Mailing Address - Country:US
Mailing Address - Phone:215-855-1438
Mailing Address - Fax:
Practice Address - Street 1:461 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-2511
Practice Address - Country:US
Practice Address - Phone:215-855-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS176631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice