Provider Demographics
NPI:1245574235
Name:SHEVINSKY, STEVEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:SHEVINSKY
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 1:1530 MAIN ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-5244
Mailing Address - Country:US
Mailing Address - Phone:760-789-8060
Mailing Address - Fax:
Practice Address - Street 1:1530 MAIN ST
Practice Address - Street 2:SUITE 17
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-5244
Practice Address - Country:US
Practice Address - Phone:760-789-8060
Practice Address - Fax:760-789-8061
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice