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General NPI Number Information
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NPI Number | 1942859145
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Entity Type | Individual
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Provider Name | RAGY STEFAN DMD
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Gender | Male
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 16430 BEACH BLVD
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City | WESTMINSTER
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State | CA
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Zip | 92683-7859
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Country | US
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Telephone | 714-848-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 28331 VIA ALFONSE
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-7060
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Country | US
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Telephone | 949-293-8024
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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 | DDS104260
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License Number State | CA
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