| Stephan Dental | |
|
860 Jamacha Rd Suite 201 El Cajon CA 92019-6206 | |
| (619) 593-3000 | |
| (619) 593-3002 |
| Full Name | Stephan Dental |
|---|---|
| Speciality | Dentist |
| Location | 860 Jamacha Rd, El Cajon, California |
| Authorized Official Name and Position | Waleed Stephan (DENTIST) |
| Authorized Official Contact | 6195933000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stephan Dental 860 Jamacha Rd Suite 201 El Cajon CA 92019-6206 Ph: (619) 593-3000 | Stephan Dental 860 Jamacha Rd Suite 201 El Cajon CA 92019-6206 Ph: (619) 593-3000 |
| NPI Number | 1336565092 |
|---|---|
| Provider Enumeration Date | 03/05/2014 |
| Last Update Date | 10/01/2020 |
| Medicare PECOS PAC ID | 1355761297 |
|---|---|
| Medicare Enrollment ID | O20201015001159 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336565092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Waleed A Stephan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1841477387 PECOS PAC ID: 2264852102 Enrollment ID: I20201015001265 |
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