Organization
STEVENSON DENTAL CLINIC FOR CHILDREN
Active
Other names
Professional Associate
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE DAVIS STEVENSON JR. DDS (OWNER)
(915) 591-1999
Entity
Organization
Contact information
Practice address
11165 LA QUINTA PLACE, EL PASO, TX 79936
(915) 591-1999
(915) 591-3201
Mailing address
11165 LA QUINTA PLACE, EL PASO, TX 79936
(915) 591-1999
(915) 591-3201
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
13513
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111009002
—
TX
01
—
828328
UNITED CONCORDIA
—
01
—
D13513
BCBS
—
01
—
G601421
DELTA CHIP
—
Enumeration date
11/09/2006
Last updated
10/01/2009
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