Healthcare Provider Details

I. General information

NPI: 1669255675
Provider Name (Legal Business Name): NINA KHANNA STEVENS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42420 WASHINGTON ST
BERMUDA DUNES CA
92203-8156
US

IV. Provider business mailing address

42420 WASHINGTON ST
BERMUDA DUNES CA
92203-8156
US

V. Phone/Fax

Practice location:
  • Phone: 760-797-7126
  • Fax:
Mailing address:
  • Phone: 760-797-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number107023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: