Provider Demographics
NPI:1821292897
Name:STEVENSON ORTHODONTICS, P.A.
Entity Type:Organization
Organization Name:STEVENSON ORTHODONTICS, P.A.
Other - Org Name:STEVENSON ORTHODONTICS, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-693-1333
Mailing Address - Street 1:2830 COMMERCIAL CENTER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6405
Mailing Address - Country:US
Mailing Address - Phone:281-693-1333
Mailing Address - Fax:281-693-2207
Practice Address - Street 1:2830 COMMERCIAL CENTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6405
Practice Address - Country:US
Practice Address - Phone:281-693-1333
Practice Address - Fax:281-693-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty