Provider Demographics
NPI:1346522299
Name:VAN S. STEVENS, DMD PA
Entity Type:Organization
Organization Name:VAN S. STEVENS, DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-233-7711
Mailing Address - Street 1:213 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2316
Mailing Address - Country:US
Mailing Address - Phone:908-233-7711
Mailing Address - Fax:908-233-0506
Practice Address - Street 1:213 SUMMIT RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2316
Practice Address - Country:US
Practice Address - Phone:908-233-7711
Practice Address - Fax:908-233-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI100621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty