Provider Demographics
NPI:1366761249
Name:STUTMAN, DORY HARRIS (DDS)
Entity type:Individual
Prefix:
First Name:DORY
Middle Name:HARRIS
Last Name:STUTMAN
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 1:1068 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1268
Mailing Address - Country:US
Mailing Address - Phone:516-798-3808
Mailing Address - Fax:516-798-5182
Practice Address - Street 1:1068 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1268
Practice Address - Country:US
Practice Address - Phone:516-798-3808
Practice Address - Fax:516-798-5182
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0439511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice