Provider Demographics
NPI:1386715159
Name:STEVENS, FORD W (DMD)
Entity type:Individual
Prefix:DR
First Name:FORD
Middle Name:W
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 INSKEEP AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-2304
Mailing Address - Country:US
Mailing Address - Phone:610-532-7834
Mailing Address - Fax:
Practice Address - Street 1:427 SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1418
Practice Address - Country:US
Practice Address - Phone:610-259-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS20055L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist