Provider Demographics
NPI:1497889356
Name:STEVENS, SHEA F (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHEA
Middle Name:F
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FARMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-7912
Mailing Address - Country:US
Mailing Address - Phone:717-534-1135
Mailing Address - Fax:717-534-1449
Practice Address - Street 1:10 W CHOCOLATE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1472
Practice Address - Country:US
Practice Address - Phone:717-534-1135
Practice Address - Fax:717-534-1449
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0366861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice