Provider Demographics
NPI:1972628774
Name:DAFTINC AND STAMOSINC
Entity Type:Organization
Organization Name:DAFTINC AND STAMOSINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-966-1751
Mailing Address - Street 1:10425 FAIR OAKS BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7559
Mailing Address - Country:US
Mailing Address - Phone:916-966-1751
Mailing Address - Fax:916-966-8513
Practice Address - Street 1:10425 FAIR OAKS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7559
Practice Address - Country:US
Practice Address - Phone:916-966-1751
Practice Address - Fax:916-966-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28244OtherDENTLICENSECHARLESTSTAMOS
CA22335OtherDENTALLICENSEKENT S. DAFT