Healthcare Provider Details

I. General information

NPI: 1588668008
Provider Name (Legal Business Name): STEPHEN R. JOHN, DDS, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 01/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 WALNUT ST
SAN CARLOS CA
94070-3913
US

IV. Provider business mailing address

205 DE ANZA BLVD #41
SAN MATEO CA
94402
US

V. Phone/Fax

Practice location:
  • Phone: 650-430-0186
  • Fax: 650-571-8116
Mailing address:
  • Phone: 650-430-0186
  • Fax: 650-571-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number32858
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN ROBERT JOHN
Title or Position: PRESIDENT
Credential: DDS
Phone: 650-430-0186