Provider Demographics
NPI:1124483276
Name:STEPHANIE A. DODSON DDS MS
Entity type:Organization
Organization Name:STEPHANIE A. DODSON DDS MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:562-230-1116
Mailing Address - Street 1:337 E AVOCADO CREST RD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:90631-8125
Mailing Address - Country:US
Mailing Address - Phone:562-230-1116
Mailing Address - Fax:562-598-0005
Practice Address - Street 1:4608 KATELLA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2684
Practice Address - Country:US
Practice Address - Phone:562-430-0541
Practice Address - Fax:562-598-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39393261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental