Provider Demographics
NPI:1174970446
Name:COMSTOCK, STEPHEN PHILIP (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PHILIP
Last Name:COMSTOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LAFAYETTE CIR
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-4420
Mailing Address - Country:US
Mailing Address - Phone:401-829-0183
Mailing Address - Fax:
Practice Address - Street 1:117 DRUM HILL RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1505
Practice Address - Country:US
Practice Address - Phone:978-454-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice