Individual
NICOLE R STEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.A.
Contact information
Practice address
17922 SHELL ROAD, JAMESTOWN ROAD, CA 95327
(209) 890-5905
Mailing address
800 MORNING STAR DR, SONORA, CA 95370-9260
(209) 588-8400
(209) 588-8811
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
74885
CA
Other
Enumeration date
04/28/2010
Last updated
04/28/2010
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