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Organization
STEPHENS DENTAL
Active
Organization
STEPHENS DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAYLORD MEDALLON (MANAGER)
(619) 497-0122
Entity
Organization
Contact information
Practice address
3588 4TH AVE STE 300, SAN DIEGO, CA 92103-4947
(619) 497-0122
(619) 497-0264
Mailing address
3588 4TH AVE STE 300, SAN DIEGO, CA 92103-4947
(619) 497-0122
(619) 497-0264
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/18/2026
Last updated
05/18/2026
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