Provider Demographics
NPI:1598196479
Name:STEVENSON, CLAUDINE LOVE
Entity Type:Individual
Prefix:MRS
First Name:CLAUDINE
Middle Name:LOVE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SE GODSEY RD APT 97
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2797
Mailing Address - Country:US
Mailing Address - Phone:503-877-7249
Mailing Address - Fax:
Practice Address - Street 1:1250 SE GODSEY RD APT 97
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2797
Practice Address - Country:US
Practice Address - Phone:503-877-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5776124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist