Organization
ROBERT O STEVENS DMD, PA
Active
Other names
Bethel Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT ORLO STEVENS (DENTIST OWNER)
(208) 375-5656
Entity
Organization
Contact information
Practice address
10572 W BUSINESS PARK LN, BOISE, ID 83709-6797
(208) 375-5656
(208) 375-5928
Mailing address
10572 W BUSINESS PARK LN, BOISE, ID 83709-6797
(208) 375-5656
(208) 375-5928
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D1807
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43162
REGENCE BLUE SHIELD
ID
01
—
64709
BLUE CROSS
ID
Enumeration date
10/18/2006
Last updated
05/13/2013
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