Provider Demographics
NPI:1033117056
Name:STEVENS, LAMONT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAMONT
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MONTE
Other - Middle Name:C
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5232 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-5002
Mailing Address - Country:US
Mailing Address - Phone:541-884-9339
Mailing Address - Fax:541-884-0454
Practice Address - Street 1:5232 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-5002
Practice Address - Country:US
Practice Address - Phone:541-884-9339
Practice Address - Fax:541-884-0454
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD76421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice