Provider Demographics
NPI:1639398399
Name:STEVENS, MINDY J (DDS)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:J
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4249
Mailing Address - Country:US
Mailing Address - Phone:712-274-2338
Mailing Address - Fax:712-274-8056
Practice Address - Street 1:5708 SUNNYBROOK DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4249
Practice Address - Country:US
Practice Address - Phone:712-274-2338
Practice Address - Fax:712-274-8056
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist