Provider Demographics
NPI:1649683335
Name:STEVENS, ERIC DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DANIEL
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 1:10484 STRINGFELLOW RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ST JAMES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33956-3209
Mailing Address - Country:US
Mailing Address - Phone:239-283-1041
Mailing Address - Fax:239-283-1684
Practice Address - Street 1:2700 PGA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2958
Practice Address - Country:US
Practice Address - Phone:561-622-6100
Practice Address - Fax:561-622-6107
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 206571223G0001X
FLDN206571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN20657OtherSTATE OF FLORIDA