Individual
KEITH ANDREW STEVENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
527 E GENESEE ST, FAYETTEVILLE, NY 13066-1536
(315) 637-8213
Mailing address
527 E GENESEE ST, FAYETTEVILLE, NY 13066-1536
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
50054495
NY
122300000X
Dentist
TD-00-21
NM
Other
Enumeration date
07/31/2009
Last updated
10/19/2011
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