Healthcare Provider Details

I. General information

NPI: 1962528893
Provider Name (Legal Business Name): DAFTINC AND STAMOS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 K ST SUITE 106
SACRAMENTO CA
95816-5114
US

IV. Provider business mailing address

2525 K ST SUITE 106
SACRAMENTO CA
95816-5114
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-3925
  • Fax: 916-441-2855
Mailing address:
  • Phone: 916-441-3925
  • Fax: 916-441-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22335
License Number StateCA

VIII. Authorized Official

Name: DR. KENT S. DAFT
Title or Position: PARTNER
Credential: DDS
Phone: 919-441-3925