Provider Demographics
NPI:1609970086
Name:STEVENS, THOMAS CYRIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CYRIEL
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 1:2100 PENFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568-0029
Mailing Address - Country:US
Mailing Address - Phone:315-986-1144
Mailing Address - Fax:315-986-3191
Practice Address - Street 1:2100 PENFIELD RD.
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:NY
Practice Address - Zip Code:14568-0029
Practice Address - Country:US
Practice Address - Phone:315-986-1144
Practice Address - Fax:315-986-3191
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0277731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice