Provider Demographics
NPI:1962528893
Name:DAFTINC AND STAMOS INC
Entity type:Organization
Organization Name:DAFTINC AND STAMOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-441-3925
Mailing Address - Street 1:2525 K ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5114
Mailing Address - Country:US
Mailing Address - Phone:916-441-3925
Mailing Address - Fax:916-441-2855
Practice Address - Street 1:2525 K ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5114
Practice Address - Country:US
Practice Address - Phone:916-441-3925
Practice Address - Fax:916-441-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22335OtherLICENSEKSDAFT
CA28244OtherLICENSECTSTAMOS