Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | CA16572 | CA |
NPI | 1063855997 |
---|---|
Provider Name | Heather Lynn Stephens |
First Address | Concord, CA 94521-4053 |
Second Address | Concord, CA 94521-4053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 03/04/2021 |