Provider Demographics
NPI:1861868903
Name:DEPASQUALE, STEPHEN
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:DEPASQUALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 NC HIGHWAY 42 W STE 109
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7998
Mailing Address - Country:US
Mailing Address - Phone:919-772-4221
Mailing Address - Fax:
Practice Address - Street 1:5638 NC HIGHWAY 42 W STE 109
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7998
Practice Address - Country:US
Practice Address - Phone:919-772-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN205101223X0400X
NC101941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics