Basic Information
| Provider Information | |||||||||
| NPI: | 1548808835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEPANEK | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | HANA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS, MSD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3063 LARKIN RD | ||||||||
| Address2: | |||||||||
| City: | PEBBLE BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939532910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312331236 | ||||||||
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| Practice Location | |||||||||
| Address1: | 962 SEPULVEDA BLVD | ||||||||
| Address2: | |||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907101405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105393245 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2019 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | DDS103874 | CA | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.