Provider Demographics
NPI:1154534915
Name:STEVENER, MICHAEL ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:STEVENER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034-2303
Mailing Address - Country:US
Mailing Address - Phone:603-483-2663
Mailing Address - Fax:
Practice Address - Street 1:39 FREETOWN RD
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-2359
Practice Address - Country:US
Practice Address - Phone:603-895-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice