Provider Demographics
NPI:1821186164
Name:STEVENS, TANYA (DDS)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TANTA
Other - Middle Name:
Other - Last Name:STERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7580 NORMAN ROCKWELL LN STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-6019
Mailing Address - Country:US
Mailing Address - Phone:702-202-3400
Mailing Address - Fax:
Practice Address - Street 1:7580 NORMAN ROCKWELL LN STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89143-6019
Practice Address - Country:US
Practice Address - Phone:702-202-3400
Practice Address - Fax:702-202-6800
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49997122300000X
NV4364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist