Provider Demographics
NPI:1881999282
Name:D. SCOTT STEVINSON DDS/ MICHAEL J. STEVINSON DDS
Entity type:Organization
Organization Name:D. SCOTT STEVINSON DDS/ MICHAEL J. STEVINSON DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-661-6080
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:559-674-3140
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:559-674-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338531223G0001X
CA308621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty