Provider Demographics
NPI:1982754180
Name:KINERET, STEPHEN ELAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ELAN
Last Name:KINERET
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:6819 LONETREE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5877
Mailing Address - Country:US
Mailing Address - Phone:916-772-5832
Mailing Address - Fax:916-772-7586
Practice Address - Street 1:6819 LONETREE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5877
Practice Address - Country:US
Practice Address - Phone:916-772-5832
Practice Address - Fax:916-772-7586
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA257691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics