Provider Demographics
NPI:1033427117
Name:MANN, STEPHEN FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRANCIS
Last Name:MANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 LAKE MURRAY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1334
Mailing Address - Country:US
Mailing Address - Phone:619-697-1021
Mailing Address - Fax:619-697-1650
Practice Address - Street 1:5308 LAKE MURRAY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1334
Practice Address - Country:US
Practice Address - Phone:619-697-1021
Practice Address - Fax:619-697-1650
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist