Provider Demographics
NPI:1114925930
Name:STEPHENSON, ROBERT H (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:STEPHENSON
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 1:700 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6001
Mailing Address - Country:US
Mailing Address - Phone:541-343-8527
Mailing Address - Fax:541-349-0510
Practice Address - Street 1:700 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6001
Practice Address - Country:US
Practice Address - Phone:541-343-8527
Practice Address - Fax:541-349-0510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
439516OtherUNITED CONCORDIA