Provider Demographics
NPI:1467469213
Name:STEVENSON, WILLIAM CRISMAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CRISMAN
Last Name:STEVENSON
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 1:3809 PLAZA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4625
Mailing Address - Country:US
Mailing Address - Phone:760-631-6302
Mailing Address - Fax:760-631-1682
Practice Address - Street 1:3809 PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4625
Practice Address - Country:US
Practice Address - Phone:760-631-6302
Practice Address - Fax:760-631-1682
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30666OtherCA DENTAL BOARD
CABS1745667OtherDEA