Provider Demographics
NPI:1689792368
Name:STEPHENSON, CYNTHIA ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 N BROADWAY
Mailing Address - Street 2:SUITE # 212
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3852
Mailing Address - Country:US
Mailing Address - Phone:925-938-6000
Mailing Address - Fax:925-938-6001
Practice Address - Street 1:1981 N BROADWAY
Practice Address - Street 2:SUITE # 212
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3852
Practice Address - Country:US
Practice Address - Phone:925-938-6000
Practice Address - Fax:925-938-6001
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist