Healthcare Provider Details

I. General information

NPI: 1063855997
Provider Name (Legal Business Name): HEATHER LYNN STEPHENS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 07/03/2023
Certification Date: 07/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 WASHINGTON BLVD STE D
CONCORD CA
94521-4053
US

IV. Provider business mailing address

1494 WASHINGTON BLVD STE D
CONCORD CA
94521-4053
US

V. Phone/Fax

Practice location:
  • Phone: 925-672-6200
  • Fax: 925-672-2645
Mailing address:
  • Phone: 925-672-6200
  • Fax: 925-672-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberCA65172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: