# STEVENSON PEDIATRIC DENTISTRY P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578638854
- **Authorized official:** DR. NATHAN DANIEL STEVENSON D.D.S. (OWNER, PRESIDENT)
- **Authorized official phone:** (801) 302-7938

## Contact information

- **Practice address:** 4019 W. 12600 S., SUITE 200, RIVERTON, UT 84096
- **Practice address phone:** (801) 302-7938
- **Practice address fax:** (801) 302-9409
- **Mailing address:** 4019 W 12600 S, SUITE 200, RIVERTON, UT 84096
- **Mailing address phone:** (801) 302-7938
- **Mailing address fax:** (801) 302-9409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 5863508-9923 | UT | Yes |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 11/18/2014