Provider Demographics
NPI:1992837025
Name:STEVENS, BRYAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:M
Last Name:STEVENS
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 1:886 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3769
Mailing Address - Country:US
Mailing Address - Phone:909-373-7743
Mailing Address - Fax:909-982-2500
Practice Address - Street 1:886 W FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3769
Practice Address - Country:US
Practice Address - Phone:909-373-7743
Practice Address - Fax:909-982-2500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist