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General NPI Number Information
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NPI Number | 1114240603
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Entity Type | Individual
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Provider Name | FLORA P. STAY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 4105 CLUBHOUSE DR
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City | SOMIS
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State | CA
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Zip | 93066-9793
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Country | US
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Telephone | 805-201-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 CLUBHOUSE DR
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City | SOMIS
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State | CA
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Zip | 93066-9793
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Country | US
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Telephone | 805-201-5885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28261
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License Number State | CA
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