Individual
DR. PAUL STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1385 N JACKSONMILL AVE, KUNA, ID 83634-2042
(208) 606-4816
Mailing address
3646 E MARDIA ST, MERIDIAN, ID 83642-5481
(801) 400-4533
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9438
KY
1223P0221X
Pediatric Dentistry
188794
AK
1223P0221X
Pediatric Dentistry
Primary
D-5149-PD
ID
1223P0221X
Pediatric Dentistry
D10877
OR
Other
Enumeration date
06/17/2014
Last updated
05/10/2022
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