Healthcare Provider Details

I. General information

NPI: 1225139629
Provider Name (Legal Business Name): JOHN CRAIG STEVENS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BRYSON DR
SUTTER CREEK CA
95685-4118
US

IV. Provider business mailing address

15661 YORK LN
JACKSON CA
95642-9327
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-2070
  • Fax: 209-267-0446
Mailing address:
  • Phone: 209-296-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: