Provider Demographics
NPI:1891998795
Name:STEVENS, RICHARD M (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4991 HAYRIDE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4760
Mailing Address - Country:US
Mailing Address - Phone:702-326-1793
Mailing Address - Fax:
Practice Address - Street 1:5422 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 20
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4717
Practice Address - Country:US
Practice Address - Phone:602-439-1400
Practice Address - Fax:602-439-1600
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-421223X0400X
AZD0083201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics