Provider Demographics
NPI:1750445862
Name:BEVERIDGE, STEPHEN LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEIGH
Last Name:BEVERIDGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 ROSS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3038
Mailing Address - Country:US
Mailing Address - Phone:408-267-2303
Mailing Address - Fax:408-267-5840
Practice Address - Street 1:3535 ROSS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3038
Practice Address - Country:US
Practice Address - Phone:408-267-2303
Practice Address - Fax:408-267-5840
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice