Provider Demographics
NPI:1659717916
Name:STEVENS, ROBERT ORLO (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ORLO
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10572 W. BUSINESS PARK LANE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709
Mailing Address - Country:US
Mailing Address - Phone:208-375-5656
Mailing Address - Fax:208-375-5928
Practice Address - Street 1:10572 W BUSINESS PARK LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-6797
Practice Address - Country:US
Practice Address - Phone:208-375-5656
Practice Address - Fax:208-375-5928
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist