Provider Demographics
NPI:1538323043
Name:NOZAKI, STEPHEN NOBUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NOBUO
Last Name:NOZAKI
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 1:3453 BROOKSIDE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219
Mailing Address - Country:US
Mailing Address - Phone:209-955-1500
Mailing Address - Fax:209-955-1697
Practice Address - Street 1:3453 BROOKSIDE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219
Practice Address - Country:US
Practice Address - Phone:209-955-1500
Practice Address - Fax:209-955-1697
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571651223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice