Provider Demographics
NPI:1124048749
Name:STEPHENS, ROY O (DDS)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:O
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 EL CAJON BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-3655
Mailing Address - Country:US
Mailing Address - Phone:619-469-0494
Mailing Address - Fax:619-667-9050
Practice Address - Street 1:7900 EL CAJON BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3655
Practice Address - Country:US
Practice Address - Phone:619-469-0494
Practice Address - Fax:619-667-9050
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist