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Organization
STEPHEN MIKLETHUN DDS PC
Active
Organization
STEPHEN MIKLETHUN DDS PC
Active
Other names
Riverside Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN JOHN MIKLETHUN DDS (OWNER)
(315) 219-5516
Entity
Organization
Contact information
Practice address
338 E STATE ST, SUITE A, HERKIMER, NY 13350-2026
(315) 219-5516
(315) 219-5517
Mailing address
338 E STATE ST, SUITE A, HERKIMER, NY 13350-2026
(315) 219-5516
(315) 219-5517
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
050917-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619043528
INDIVIDUAL NPI
—
Enumeration date
02/28/2007
Last updated
08/22/2020
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