Provider Demographics
NPI:1225259849
Name:ROSCELLI, STEVEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:ROSCELLI
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 1:4255 PACIFIC AVENUE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-9520
Mailing Address - Country:US
Mailing Address - Phone:209-478-3723
Mailing Address - Fax:209-479-3729
Practice Address - Street 1:4255 PACIFIC AVENUE
Practice Address - Street 2:SUITE 7
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-9520
Practice Address - Country:US
Practice Address - Phone:209-478-3723
Practice Address - Fax:209-479-3729
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice