Individual
STEPHANIE MEDEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
53 CHESTER ST, LAKE GROVE, NY 11755-3047
(631) 455-2971
Mailing address
53 CHESTER ST, LAKE GROVE, NY 11755-3047
(631) 455-2971
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
02746301
NY
Other
Enumeration date
09/13/2021
Last updated
09/13/2021
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