Provider Demographics
NPI:1033255237
Name:STEVENSON, NEIL K (DMD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:K
Last Name:STEVENSON
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 1:12078 SAN JOSE BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1842
Mailing Address - Country:US
Mailing Address - Phone:904-268-4466
Mailing Address - Fax:904-268-5904
Practice Address - Street 1:12078 SAN JOSE BLVD # 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1842
Practice Address - Country:US
Practice Address - Phone:904-268-4466
Practice Address - Fax:904-268-5904
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00131811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice