Healthcare Provider Details

I. General information

NPI: 1134062631
Provider Name (Legal Business Name): ASHLEY STEVENSON DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 W 83RD ST STE 239
PRAIRIE VILLAGE KS
66208-5323
US

IV. Provider business mailing address

3408 SOMERSET DR
PRAIRIE VILLAGE KS
66206-1143
US

V. Phone/Fax

Practice location:
  • Phone: 913-385-5950
  • Fax:
Mailing address:
  • Phone: 573-248-6802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY STEVENSON
Title or Position: DOCTOR
Credential: DDS
Phone: 573-248-6802