Provider Demographics
NPI:1205868494
Name:CANFIELD, STEVEN CHARLES (DDS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CHARLES
Last Name:CANFIELD
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 1:253 W MARQUITA
Mailing Address - Street 2:UNIT F
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5184
Mailing Address - Country:US
Mailing Address - Phone:949-392-3433
Mailing Address - Fax:
Practice Address - Street 1:31105 RANCHO VIEJO RD
Practice Address - Street 2:SUITE C2
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1717
Practice Address - Country:US
Practice Address - Phone:949-218-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV25141223G0001X
CA36343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205868494Medicare PIN