Provider Demographics
NPI:1144248139
Name:MASTELLA, STEPHEN B (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:MASTELLA
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 1:1030 N CHARLES ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5402
Mailing Address - Country:US
Mailing Address - Phone:410-685-2850
Mailing Address - Fax:410-685-4086
Practice Address - Street 1:1030 N CHARLES ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5402
Practice Address - Country:US
Practice Address - Phone:410-685-2850
Practice Address - Fax:410-685-4086
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD93841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice