Provider Demographics
NPI:1215140405
Name:STEIN, DEBRA (DMD, MMSC)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-6420
Mailing Address - Country:US
Mailing Address - Phone:310-551-1902
Mailing Address - Fax:310-556-3031
Practice Address - Street 1:10231 SANTA MONICA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-6420
Practice Address - Country:US
Practice Address - Phone:310-975-4451
Practice Address - Fax:310-556-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517961223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics