Provider Demographics
NPI:1083960793
Name:SMITH, STEVENSON SANDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVENSON
Middle Name:SANDER
Last Name:SMITH
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 1:911 COUNTRY CLUB RD STE 222
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6046
Mailing Address - Country:US
Mailing Address - Phone:801-885-7639
Mailing Address - Fax:
Practice Address - Street 1:911 COUNTRY CLUB RD STE 222
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6046
Practice Address - Country:US
Practice Address - Phone:541-342-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice