Provider Demographics
NPI:1508164120
Name:MICHAEL J. STEPOVICH, DDS, MS, INC.
Entity Type:Organization
Organization Name:MICHAEL J. STEPOVICH, DDS, MS, INC.
Other - Org Name:STEPOVICH ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEPOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:408-358-2400
Mailing Address - Street 1:1757 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-6212
Mailing Address - Country:US
Mailing Address - Phone:408-358-2400
Mailing Address - Fax:408-358-3250
Practice Address - Street 1:1757 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 30
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-6212
Practice Address - Country:US
Practice Address - Phone:408-358-2400
Practice Address - Fax:408-358-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA357861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty