Individual
ALLAN WALKER STEVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
206 GROVE AVE., PARMA, ID 83660
(208) 722-6400
(208) 722-9016
Mailing address
206 GROVE AVE., PO BOX 420, PARMA, ID 83660
(208) 722-6400
(208) 722-9016
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3204
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804061600
—
ID
Enumeration date
07/23/2008
Last updated
07/23/2008
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