MEDICARE: DR. STEPHEN DOAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	028435	CA

General Provider Information

NPI Number	:	1801895628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN DOAN DMD

Provider Business Mailing Address
First Line	:	7040 AVENIDA ENCINAS STE 104-548
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-4652
Country	:	US
Telephone Number	:	760-929-1023
Fax Number	:

Provider Business Practice Location Address
First Line	:	8899 UNIVERSITY CENTER LN
Second Line	:	SUITE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1013
Country	:	US
Telephone Number	:	858-452-1504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	10/11/2022

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