Provider Demographics
NPI:1023054384
Name:ANCOWITZ, STEPHEN JAY
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAY
Last Name:ANCOWITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 WHITMAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1024
Mailing Address - Country:US
Mailing Address - Phone:619-296-5120
Mailing Address - Fax:310-268-3941
Practice Address - Street 1:VA GREATER LOS ANGELES HEALTHCARE SYSTEM - DENT SERVICE
Practice Address - Street 2:11301 WISHIRE BLVD.
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-3941
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327971223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics