Healthcare Provider Details

I. General information

NPI: 1740289289
Provider Name (Legal Business Name): STEPHEN PETER ESKELAND D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 REGENTS PARK ROW SUITE 100
LA JOLLA CA
92037-9124
US

IV. Provider business mailing address

4150 REGENTS PARK ROW SUITE 100
LA JOLLA CA
92037-9124
US

V. Phone/Fax

Practice location:
  • Phone: 858-587-9077
  • Fax: 858-587-4663
Mailing address:
  • Phone: 858-587-9077
  • Fax: 858-587-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: