Provider Demographics
NPI:1942859145
Name:STEFAN, RAGY (DMD)
Entity Type:Individual
Prefix:
First Name:RAGY
Middle Name:
Last Name:STEFAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28331 VIA ALFONSE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7060
Mailing Address - Country:US
Mailing Address - Phone:949-293-8024
Mailing Address - Fax:
Practice Address - Street 1:16430 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7859
Practice Address - Country:US
Practice Address - Phone:714-848-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS104260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist