Provider Demographics
NPI:1841477387
Name:STEPHAN, WALEED A (DDS)
Entity type:Individual
Prefix:DR
First Name:WALEED
Middle Name:A
Last Name:STEPHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WALEED
Other - Middle Name:E
Other - Last Name:ASHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:860 JAMACHA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3224
Mailing Address - Country:US
Mailing Address - Phone:619-593-3000
Mailing Address - Fax:619-593-3002
Practice Address - Street 1:860 JAMACHA RD STE 201
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3224
Practice Address - Country:US
Practice Address - Phone:619-593-3000
Practice Address - Fax:619-593-3002
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist