Provider Demographics
NPI:1487736591
Name:STEPHENS, WILLIAM FREDERICK (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FREDERICK
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 1:301 S FAIR OAKS AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2536
Mailing Address - Country:US
Mailing Address - Phone:626-440-0099
Mailing Address - Fax:626-440-1002
Practice Address - Street 1:301 S FAIR OAKS AVE STE 107
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2536
Practice Address - Country:US
Practice Address - Phone:626-440-0099
Practice Address - Fax:626-440-1002
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWD34775AMedicare ID - Type Unspecified
CAT16101Medicare UPIN