Individual
STEPHANIE LIANE SUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2277 MICHAEL DR STE 2, NEWBURY PARK, CA 91320-3263
(805) 498-2802
Mailing address
2277 MICHAEL DR STE 2, NEWBURY PARK, CA 91320-3263
(805) 728-5739
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DDS105961
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/18/2019
Last updated
05/24/2022
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