Provider Demographics
NPI:1518127141
Name:GREGORY D. STEVENS, D.D.S., LLC
Entity Type:Organization
Organization Name:GREGORY D. STEVENS, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS, D.D.S., LLC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-445-9526
Mailing Address - Street 1:1601 CHAPEL HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5462
Mailing Address - Country:US
Mailing Address - Phone:573-445-9526
Mailing Address - Fax:573-445-7950
Practice Address - Street 1:1601 CHAPEL HILL RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5462
Practice Address - Country:US
Practice Address - Phone:573-445-9526
Practice Address - Fax:573-445-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO016155261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental