Provider Demographics
NPI:1699871921
Name:STEVENSON, DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:STEVENSON
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 1:1136 FREMONT AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5757
Mailing Address - Country:US
Mailing Address - Phone:323-682-3377
Mailing Address - Fax:323-255-6636
Practice Address - Street 1:1136 FREMONT AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5757
Practice Address - Country:US
Practice Address - Phone:323-682-3377
Practice Address - Fax:323-255-6636
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist