MEDICARE: DR. RICHARD C STEVENS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901015389	MI

General Provider Information

NPI Number	:	1699870782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C STEVENS DDS

Provider Business Mailing Address
First Line	:	425 W HURON ST
Second Line	:	SUITE 140
City	:	MILFORD
State	:	MI
Zip	:	48381-2242
Country	:	US
Telephone Number	:	248-684-9555
Fax Number	:	248-684-9777

Provider Business Practice Location Address
First Line	:	425 W HURON ST
Second Line	:	SUITE 140
City	:	MILFORD
State	:	MI
Zip	:	48381-2242
Country	:	US
Telephone Number	:	248-684-9555
Fax Number	:	248-684-9777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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