Individual
TYRONE HAROLD STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3129 TACOMA ST, CHARLOTTE, NC 28208-2681
(601) 336-2669
Mailing address
3129 TACOMA ST, CHARLOTTE, NC 28208-2681
(601) 336-2669
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
000008606466
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000008606466
—
NC
Enumeration date
12/22/2021
Last updated
12/22/2021
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