Provider Demographics
NPI:1477747111
Name:ICELAND, STEVEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:ICELAND
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 1:5353 REYES ADOBE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2083
Mailing Address - Country:US
Mailing Address - Phone:818-991-5004
Mailing Address - Fax:818-991-3996
Practice Address - Street 1:5353 REYES ADOBE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2083
Practice Address - Country:US
Practice Address - Phone:818-991-5004
Practice Address - Fax:818-991-3996
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD24670Medicaid