Provider Demographics
NPI:1477684751
Name:STEPHENS, DENISE (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 PLEASANT VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2220
Mailing Address - Country:US
Mailing Address - Phone:619-227-8855
Mailing Address - Fax:
Practice Address - Street 1:2237 PLEASANT VALLEY PL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2220
Practice Address - Country:US
Practice Address - Phone:619-227-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP118124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist