Provider Demographics
NPI:1588668008
Name:STEPHEN R. JOHN, DDS, APC
Entity Type:Organization
Organization Name:STEPHEN R. JOHN, DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-430-0186
Mailing Address - Street 1:205 DE ANZA BLVD #41
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:650-430-0186
Mailing Address - Fax:650-571-8116
Practice Address - Street 1:731 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3913
Practice Address - Country:US
Practice Address - Phone:650-430-0186
Practice Address - Fax:650-571-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty