Provider Demographics
NPI:1003616053
Name:W A STEPHAN, A DENTAL CORPORATION
Entity type:Organization
Organization Name:W A STEPHAN, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:HAIFA
Authorized Official - Last Name:KISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-300-9980
Mailing Address - Street 1:860 JAMACHA ROAD SUITE 201
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019
Mailing Address - Country:US
Mailing Address - Phone:619-593-3000
Mailing Address - Fax:858-483-1051
Practice Address - Street 1:860 JAMACHA ROAD SUITE 201
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019
Practice Address - Country:US
Practice Address - Phone:619-593-3000
Practice Address - Fax:858-483-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty