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General NPI Number Information
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NPI Number | 1679663983
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Entity Type | Individual
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Provider Name | STEPHEN LAURENCE PASTERNAK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 303 LUCE AVE
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City | UKIAH
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State | CA
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Zip | 95482-5667
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Country | US
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Telephone | 707-462-5071
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Fax | 707-462-8219
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Provider Business Mailing Address
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Address Line | 1600 WILDWOOD RD
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City | UKIAH
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State | CA
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Zip | 95482-3645
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Country | US
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Telephone | 707-468-5939
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D23360
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License Number State | CA
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