Provider Demographics
NPI:1346459237
Name:HIROSHIGE, STEPHEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:HIROSHIGE
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 1:9802 GARRETT CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3638
Mailing Address - Country:US
Mailing Address - Phone:714-964-5164
Mailing Address - Fax:310-323-4383
Practice Address - Street 1:1600 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE #306
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3226
Practice Address - Country:US
Practice Address - Phone:310-323-2842
Practice Address - Fax:310-323-4383
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice