Provider Demographics
NPI:1215587787
Name:STEPHEN BEVERIDGE DDS INC
Entity Type:Organization
Organization Name:STEPHEN BEVERIDGE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BEVERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-267-2303
Mailing Address - Street 1:3535 ROSS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3054
Mailing Address - Country:US
Mailing Address - Phone:408-267-2303
Mailing Address - Fax:408-267-5840
Practice Address - Street 1:3535 ROSS AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3054
Practice Address - Country:US
Practice Address - Phone:408-267-2303
Practice Address - Fax:408-267-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty