Provider Demographics
NPI:1942392436
Name:MUNROE, STEPHEN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:MUNROE
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 1:1000 WEST WASHINGTON STREET
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-297-0700
Mailing Address - Fax:619-704-0688
Practice Address - Street 1:1000 WEST WASHINGTON STREET
Practice Address - Street 2:SUITE ONE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-297-0700
Practice Address - Fax:619-704-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499421223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA205433110OtherTIN