Basic Information
| Provider Information | |||||||||
| NPI: | 1487736591 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | FREDERICK | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 S FAIR OAKS AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264400099 | ||||||||
| FaxNumber: | 6264401002 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 S FAIR OAKS AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264400099 | ||||||||
| FaxNumber: | 6264401002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 34775 | CA | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.