Provider Demographics
NPI:1043394133
Name:STEVENS, HERBERT RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:RAY
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 1:1326 W LEONARD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454
Mailing Address - Country:US
Mailing Address - Phone:812-723-2130
Mailing Address - Fax:812-723-2130
Practice Address - Street 1:1326 W LEONARD CIRCLE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454
Practice Address - Country:US
Practice Address - Phone:812-723-2130
Practice Address - Fax:812-723-2130
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006653A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice