Provider Demographics
NPI:1235308776
Name:STEVENS, DANIEL EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWARD
Last Name:STEVENS
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 1:2535 TRUXTUN RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6160
Mailing Address - Country:US
Mailing Address - Phone:619-224-5000
Mailing Address - Fax:619-224-5008
Practice Address - Street 1:2535 TRUXTUN RD
Practice Address - Street 2:STE. 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6160
Practice Address - Country:US
Practice Address - Phone:619-224-5000
Practice Address - Fax:619-224-5008
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice