Provider Demographics
NPI:1073506150
Name:STEVENSON, ROBERT DEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEE
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 1:795 EAST 2ND STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2020
Mailing Address - Country:US
Mailing Address - Phone:909-706-3836
Mailing Address - Fax:
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 8
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2020
Practice Address - Country:US
Practice Address - Phone:909-706-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS36837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist