Provider Demographics
NPI:1306010830
Name:STEPHENSON, BERNIE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNIE
Middle Name:R
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 1:1400 FAWCETT PKWY
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-2808
Mailing Address - Country:US
Mailing Address - Phone:515-382-5542
Mailing Address - Fax:515-382-2385
Practice Address - Street 1:1400 FAWCETT PKWY
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-2808
Practice Address - Country:US
Practice Address - Phone:515-382-5542
Practice Address - Fax:515-382-2385
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice