Provider Demographics
NPI:1992356018
Name:DE STEFANO DENTAL CORPORATION
Entity type:Organization
Organization Name:DE STEFANO DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-576-9005
Mailing Address - Street 1:450 SUTTER ST RM 2522
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4208
Mailing Address - Country:US
Mailing Address - Phone:415-576-9005
Mailing Address - Fax:866-292-7258
Practice Address - Street 1:450 SUTTER ST RM 2522
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4208
Practice Address - Country:US
Practice Address - Phone:415-576-9005
Practice Address - Fax:866-292-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental