Provider Demographics
NPI:1700822020
Name:STEVENSON, MICHAEL SHANE (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHANE
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 STRATFORD RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6022
Mailing Address - Country:US
Mailing Address - Phone:256-355-1242
Mailing Address - Fax:256-355-1259
Practice Address - Street 1:1401 STRATFORD RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6022
Practice Address - Country:US
Practice Address - Phone:256-355-1242
Practice Address - Fax:256-355-1259
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery