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General NPI Number Information
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NPI Number | 1972628774
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Entity Type | Organization
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Legal Business Name | DAFTINC AND STAMOSINC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 10425 FAIR OAKS BLVD SUITE 203
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City | FAIR OAKS
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State | CA
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Zip | 95628-7559
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Country | US
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Telephone | 916-966-1751
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Fax | 916-966-8513
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Provider Business Mailing Address
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Address Line | 10425 FAIR OAKS BLVD SUITE 203
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City | FAIR OAKS
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State | CA
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Zip | 95628-7559
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Country | US
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Telephone | 916-966-1751
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Fax | 916-966-8513
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KENT S. DAFT
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Credential | DDS
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Telephone | 916-966-1751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22335
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License Number State | CA
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