Provider Demographics
NPI:1396973681
Name:STEVENS, MATTHEW ALLDREDGE (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALLDREDGE
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 1:310 N STATE ST
Mailing Address - Street 2:STE. 310
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3261
Mailing Address - Country:US
Mailing Address - Phone:503-636-9800
Mailing Address - Fax:503-636-9805
Practice Address - Street 1:310 N STATE ST
Practice Address - Street 2:STE. 310
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3261
Practice Address - Country:US
Practice Address - Phone:503-636-9800
Practice Address - Fax:503-636-9805
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD92681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice