Provider Demographics
NPI:1235398223
Name:GRASSO, STEFANO GERALDO (DMD)
Entity type:Individual
Prefix:DR
First Name:STEFANO
Middle Name:GERALDO
Last Name:GRASSO
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 1:495 W VETERANS HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3757
Mailing Address - Country:US
Mailing Address - Phone:848-222-1455
Mailing Address - Fax:848-222-1454
Practice Address - Street 1:495 W VETERANS HWY STE 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3757
Practice Address - Country:US
Practice Address - Phone:848-222-1455
Practice Address - Fax:848-222-1454
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023841001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice