Healthcare Provider Details

I. General information

NPI: 1770162265
Provider Name (Legal Business Name): STEPHENS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 04/03/2021
Certification Date: 04/03/2021
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 Number
License Number State

VIII. Authorized Official

Name: HEATHER STEPHENS
Title or Position: OWNER/ORTHODONTIST
Credential: DDS, MS
Phone: 925-672-6200