Provider Demographics
NPI:1962409268
Name:KREIZENBECK, STEPHEN L (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:KREIZENBECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:39-935 VISTA DEL SOL, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-837-1515
Mailing Address - Fax:760-837-1011
Practice Address - Street 1:39-935 VISTA DEL SOL, SUITE 100
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-837-1515
Practice Address - Fax:760-837-1011
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery