Healthcare Provider Details

I. General information

NPI: 1720282338
Provider Name (Legal Business Name): STEPHEN ALAN FOLSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13260 N 94TH DR SUITE 410
PEORIA AZ
85381-4828
US

IV. Provider business mailing address

13260 N 94TH DR SUITE 410
PEORIA AZ
85381-4828
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-4279
  • Fax: 623-977-8787
Mailing address:
  • Phone: 623-977-4279
  • Fax: 623-977-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2728
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: