Provider Demographics
NPI:1316659709
Name:STEVENSON DENTAL GROUP
Entity type:Organization
Organization Name:STEVENSON DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-868-1838
Mailing Address - Street 1:570 E ARROW HWY STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3347
Mailing Address - Country:US
Mailing Address - Phone:310-868-1838
Mailing Address - Fax:
Practice Address - Street 1:570 E ARROW HWY STE B
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3347
Practice Address - Country:US
Practice Address - Phone:310-868-1838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVENSON DENTAL SOLUTIONS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental