Provider Demographics
NPI:1679663983
Name:PASTERNAK, STEPHEN LAURENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LAURENCE
Last Name:PASTERNAK
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 1:1600 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3645
Mailing Address - Country:US
Mailing Address - Phone:707-468-5939
Mailing Address - Fax:
Practice Address - Street 1:303 LUCE AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5667
Practice Address - Country:US
Practice Address - Phone:707-462-5071
Practice Address - Fax:707-462-8219
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD233601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice