MEDICARE: MRS. ALISON C STAPAKIS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	38366	CA

General Provider Information

NPI Number	:	1104994193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISON C STAPAKIS D.D.S.

Provider Business Mailing Address
First Line	:	16382 MARUFFA CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-2134
Country	:	US
Telephone Number	:	714-840-7033
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 XIMENO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-2850
Country	:	US
Telephone Number	:	562-498-3308
Fax Number	:	562-498-6619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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