Provider Demographics
NPI:1588782734
Name:STEVENS, BENJAMIN TYLER (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TYLER
Last Name:STEVENS
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 1:26711 ALISO CREEK RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4822
Mailing Address - Country:US
Mailing Address - Phone:949-360-0845
Mailing Address - Fax:949-360-4140
Practice Address - Street 1:26711 ALISO CREEK RD STE 200B
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4822
Practice Address - Country:US
Practice Address - Phone:949-360-0845
Practice Address - Fax:949-360-4140
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice