Provider Demographics
NPI:1720258841
Name:STEPHANOS, REEM NAGUI (DDS)
Entity Type:Individual
Prefix:
First Name:REEM
Middle Name:NAGUI
Last Name:STEPHANOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3712
Mailing Address - Country:US
Mailing Address - Phone:310-396-1753
Mailing Address - Fax:310-392-3794
Practice Address - Street 1:1670 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3712
Practice Address - Country:US
Practice Address - Phone:310-396-1753
Practice Address - Fax:310-392-3794
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics