Provider Demographics
NPI:1598873291
Name:ABBOTT, STEPHEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:649 W EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7201
Mailing Address - Country:US
Mailing Address - Phone:530-342-1271
Mailing Address - Fax:530-342-3718
Practice Address - Street 1:649 W EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-7201
Practice Address - Country:US
Practice Address - Phone:530-342-1271
Practice Address - Fax:530-342-3718
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice