Provider Demographics
NPI:1275731093
Name:STEVENS, JAMES E (DR MEDICAL DENTISTRY)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DR MEDICAL DENTISTRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0127
Mailing Address - Country:US
Mailing Address - Phone:509-837-7818
Mailing Address - Fax:509-837-7415
Practice Address - Street 1:922 E EDISON AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-0127
Practice Address - Country:US
Practice Address - Phone:509-837-7818
Practice Address - Fax:509-837-7415
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600326027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist