Provider Demographics
NPI:1609241231
Name:HARADA, STEPHEN DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:HARADA
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 1:500 SANSOME ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3211
Mailing Address - Country:US
Mailing Address - Phone:415-781-1974
Mailing Address - Fax:415-781-2527
Practice Address - Street 1:500 SANSOME ST
Practice Address - Street 2:SUITE 604
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3211
Practice Address - Country:US
Practice Address - Phone:415-781-1974
Practice Address - Fax:415-781-2527
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist