Healthcare Provider Details

I. General information

NPI: 1932647658
Provider Name (Legal Business Name): STEFAN SCHNEIDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE STE 406
NEWPORT BEACH CA
92660-2401
US

IV. Provider business mailing address

24212 LAS NARANJAS DR
LAGUNA NIGUEL CA
92677
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-1601
  • Fax:
Mailing address:
  • Phone: 53-903-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDDS103207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: