Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 25799 | CA |
NPI | 1003980426 |
---|---|
Provider Name | Mr. Stephen William Garcelon |
First Address | Vacaville, CA 95688 |
Second Address | Vacaville, CA 95688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |