Provider Demographics
NPI:1912166125
Name:DUGONI, STEVEN A (DMD,MSD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:DUGONI
Suffix:
Gender:M
Credentials:DMD,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1302
Mailing Address - Country:US
Mailing Address - Phone:650-588-5042
Mailing Address - Fax:
Practice Address - Street 1:1131 MISSION RD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-1302
Practice Address - Country:US
Practice Address - Phone:650-588-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2022-04-07
Deactivation Date:2021-05-03
Deactivation Code:
Reactivation Date:2022-04-07
Provider Licenses
StateLicense IDTaxonomies
CA285411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics