Provider Demographics
NPI:1992976765
Name:DARON STEVENS ORTHODONTICS
Entity type:Organization
Organization Name:DARON STEVENS ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-468-9191
Mailing Address - Street 1:119 S VALLEY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2974
Mailing Address - Country:US
Mailing Address - Phone:208-468-9191
Mailing Address - Fax:208-466-7479
Practice Address - Street 1:119 S VALLEY DR
Practice Address - Street 2:SUITE E
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2974
Practice Address - Country:US
Practice Address - Phone:208-468-9191
Practice Address - Fax:208-466-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3738-OR1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1114933553OtherIDAHO SMILES-DR STEVENS
ID1174723472OtherIDAHO SMILES-DR FRANCIS