Stephanie Diego Dental Corporation

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

STEPHANIE DIEGO DENTAL CORPORATION

Doing business as

GLEAM DENTISTRY DENTAL OFFICE OF STEPHANIE DIEGO, DDS

Practice address

1130 Coffee Rd Ste 8a
Modesto, CA 95355-4228

Phone

(209) 566-1990

NPI assigned

Mar 29, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stephanie Diego, DDS, MPHNPI 1417571076

Title

Ceo

Phone

(209) 566-1990

Specialties & licenses 1

Addresses

Other names 1

• GLEAM DENTISTRY DENTAL OFFICE OF STEPHANIE DIEGO, DDS Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephanie J Diego, DDS, MPH

  • Dentist
  • Modesto, CA
  • NPI 1417571076
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711670400000",
    "number": "1053162727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 COFFEE RD STE 8A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554228",
            "telephone_number": "209-566-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 COFFEE RD STE 8A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554228",
            "telephone_number": "209-566-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHANIE DIEGO DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-29",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A",
        "authorized_official_last_name": "DIEGO",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-566-1990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MPH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLEAM DENTISTRY DENTAL OFFICE OF STEPHANIE DIEGO, DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gerald L Steele, D.C.
• Krystle Steeley, MA, LMFT 119349
• Scott P. Steffen, AA
• Mindy Sue Steinhoefel, RN
• Mackenzie Stender
• Stephen K Liu MD Professional Corporation
• Crystal Stephens, B.A.
• Diane Leslie Stephens, M.F.T.
• Kalissa Rae Stephens
• Melody Stephens, P.T.

• Dental Clinic/Center in Modesto, CA
• Providers in Modesto, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.