Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12012636A | IN |
NPI | 1083004063 |
---|---|
Provider Name | Dr. Stephen Spiritoso |
First Address | South Bend, IN 46635-1776 |
Second Address | South Bend, IN 46635-1776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2015 |
Last Update Date | 13/02/2020 |