Provider Demographics
NPI:1972915239
Name:STEVINSON, DAVID SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:STEVINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 EMILY WAY
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5646
Mailing Address - Country:US
Mailing Address - Phone:559-661-6080
Mailing Address - Fax:559-661-6082
Practice Address - Street 1:816 EMILY WAY
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5646
Practice Address - Country:US
Practice Address - Phone:559-661-6080
Practice Address - Fax:559-661-6082
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice