Provider Demographics
NPI:1336565092
Name:STEPHAN FAMILY DENTAL A DENTAL CORPORATION
Entity Type:Organization
Organization Name:STEPHAN FAMILY DENTAL A DENTAL CORPORATION
Other - Org Name:STEPHAN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-593-3000
Mailing Address - Street 1:860 JAMACHA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-6206
Mailing Address - Country:US
Mailing Address - Phone:619-593-3000
Mailing Address - Fax:619-593-3002
Practice Address - Street 1:860 JAMACHA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-6206
Practice Address - Country:US
Practice Address - Phone:619-593-3000
Practice Address - Fax:619-593-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty