Healthcare Provider Details

I. General information

NPI: 1801895628
Provider Name (Legal Business Name): STEPHEN DOAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8899 UNIVERSITY CENTER LN SUITE 110
SAN DIEGO CA
92122-1013
US

IV. Provider business mailing address

7040 AVENIDA ENCINAS STE 104-548
CARLSBAD CA
92011-4652
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-1504
  • Fax:
Mailing address:
  • Phone: 760-929-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number028435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: