Provider Demographics
NPI:1285613562
Name:STEVENS, RICHARD WAYNE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WAYNE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4251 ARENDELL ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2869
Mailing Address - Country:US
Mailing Address - Phone:252-240-3636
Mailing Address - Fax:252-247-2233
Practice Address - Street 1:4251 ARENDELL ST
Practice Address - Street 2:SUITE H
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2869
Practice Address - Country:US
Practice Address - Phone:252-240-3636
Practice Address - Fax:252-247-2233
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 30831223E0200X
NC87311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics