Healthcare Provider Details

I. General information

NPI: 1164041596
Provider Name (Legal Business Name): STEPHANIE MARIE STEVENS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9291 GLADES RD STE 203
BOCA RATON FL
33434-3959
US

IV. Provider business mailing address

4499 NW 88TH TER
CORAL SPRINGS FL
33065-1805
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-4453
  • Fax: 561-482-9227
Mailing address:
  • Phone: 954-608-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN24837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: