Provider Demographics
NPI:1477688232
Name:STEVENS, DAVID R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:STEVENS
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 1:368 E RIVERSIDE DR
Mailing Address - Street 2:BLDG 2A
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-673-3363
Mailing Address - Fax:435-673-0138
Practice Address - Street 1:368 E RIVERSIDE DR
Practice Address - Street 2:BLDG 2A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-673-3363
Practice Address - Fax:435-673-0138
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59291279922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist