Provider Demographics
NPI:1417063942
Name:STEPHENS, SEAN EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:EVAN
Last Name:STEPHENS
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 1:3588 4TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4940
Mailing Address - Country:US
Mailing Address - Phone:619-497-0122
Mailing Address - Fax:619-497-0264
Practice Address - Street 1:3588 4TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4940
Practice Address - Country:US
Practice Address - Phone:619-497-0122
Practice Address - Fax:619-497-0264
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist