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General NPI Number Information
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NPI Number | 1003616053
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Entity Type | Organization
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Legal Business Name | W A STEPHAN, A DENTAL CORPORATION
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 860 JAMACHA ROAD SUITE 201
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City | EL CAJON
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State | CA
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Zip | 92019
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Country | US
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Telephone | 619-593-3000
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Fax | 858-483-1051
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Provider Business Mailing Address
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Address Line | 860 JAMACHA ROAD SUITE 201
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City | EL CAJON
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State | CA
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Zip | 92019
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Country | US
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Telephone | 619-593-3000
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Fax | 858-483-1051
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER HAIFA KISS
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Credential |
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Telephone | 619-300-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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