Provider Demographics
NPI:1770180523
Name:SCOTT T STEVENSON DDS PLLC
Entity Type:Organization
Organization Name:SCOTT T STEVENSON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-627-2470
Mailing Address - Street 1:11970 SWEETWATER DR
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8199
Mailing Address - Country:US
Mailing Address - Phone:517-627-2470
Mailing Address - Fax:517-627-7816
Practice Address - Street 1:11970 SWEETWATER DR
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-8199
Practice Address - Country:US
Practice Address - Phone:517-627-2470
Practice Address - Fax:517-627-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental