| Kenneth L. Stasun D.d.s. A Professional Corporateon | |
|
423 Johnston St Half Moon Bay CA 94019-1717 | |
| (650) 726-7523 | |
| Not Available |
| Full Name | Kenneth L. Stasun D.d.s. A Professional Corporateon |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 423 Johnston St, Half Moon Bay, California |
| Authorized Official Name and Position | Kenneth Louis Stasun (PRESIDENT ORTHODONTIST) |
| Authorized Official Contact | 6507267523 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth L. Stasun D.d.s. A Professional Corporateon 423 Johnston St Half Moon Bay CA 94019-1717 Ph: (650) 726-7523 | Kenneth L. Stasun D.d.s. A Professional Corporateon 423 Johnston St Half Moon Bay CA 94019-1717 Ph: (650) 726-7523 |
| NPI Number | 1831214303 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831214303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 21516 (California) | Primary |
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