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General NPI Number Information
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NPI Number | 1407408313
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Entity Type | Individual
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Provider Name | STEPHEN YAN XUE DMD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 48 MEADOW ACCESS LN
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City | WALPOLE
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State | NH
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Zip | 03608-4416
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Country | US
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Telephone | 703-756-4719
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Fax |
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Provider Business Mailing Address
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Address Line | 6 TALUS CT
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City | SAN RAMON
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State | CA
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Zip | 94583-9124
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Country | US
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Telephone | 925-577-3829
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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 | 04502
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License Number State | NH
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