Healthcare Provider Details

I. General information

NPI: 1639717929
Provider Name (Legal Business Name): CHRISTINE PATRICIA STEPANEK DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7603 CARSON BLVD
LONG BEACH CA
90808-2367
US

IV. Provider business mailing address

3063 LARKIN RD
PEBBLE BEACH CA
93953-2910
US

V. Phone/Fax

Practice location:
  • Phone: 562-294-6671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS103875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: