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General NPI Number Information
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NPI Number | 1649349879
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Entity Type | Individual
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Provider Name | STEPHEN S KALLAOS DDS
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24099 POSTAL AVE SUITE 102
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City | MORENO VALLEY
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State | CA
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Zip | 92553-7709
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Country | US
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Telephone | 951-601-1385
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Fax | 951-601-1292
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Provider Business Mailing Address
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Address Line | 29 OROVILLE
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City | IRVINE
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State | CA
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Zip | 92602-0923
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Country | US
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Telephone | 714-317-9821
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Fax | 951-601-1385
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 44903
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License Number State | CA
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