Healthcare Provider Details

I. General information

NPI: 1407881873
Provider Name (Legal Business Name): JAMES E. STICH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 OLIVER RD
FAIRFIELD CA
94534-3470
US

IV. Provider business mailing address

1377 OLIVER RD
FAIRFIELD CA
94534-3470
US

V. Phone/Fax

Practice location:
  • Phone: 707-427-8836
  • Fax: 707-427-8807
Mailing address:
  • Phone: 707-427-8836
  • Fax: 707-427-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number36286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: