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General NPI Number Information
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NPI Number | 1023322468
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Entity Type | Organization
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Legal Business Name | S. STEVEN PODSTRELENY, DDS, PC
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 4067 PARK BLVD
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City | SAN DIEGO
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State | CA
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Zip | 92103-2619
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Country | US
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Telephone | 619-795-0154
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Fax | 619-795-0512
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Provider Business Mailing Address
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Address Line | 4067 PARK BLVD
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City | SAN DIEGO
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State | CA
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Zip | 92103-2619
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Country | US
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Telephone | 619-795-0154
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Fax | 619-795-0512
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Authorized Official
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Title or Position | OWNER
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Name | DR. STJEPAN STEVEN PODSTRELENY
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Credential | DDS
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Telephone | 619-795-0154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 50861
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License Number State | CA
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