Organization
DAFTINC AND STAMOSINC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENT S. DAFT DDS (PARTNER)
(916) 966-1751
Entity
Organization
Contact information
Practice address
10425 FAIR OAKS BLVD, SUITE 203, FAIR OAKS, CA 95628-7559
(916) 966-1751
(916) 966-8513
Mailing address
10425 FAIR OAKS BLVD, SUITE 203, FAIR OAKS, CA 95628-7559
(916) 966-1751
(916) 966-8513
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22335
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22335
DENTALLICENSEKENT S. DAFT
CA
01
—
28244
DENTLICENSECHARLESTSTAMOS
CA
Enumeration date
03/20/2007
Last updated
06/18/2008
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