Healthcare Provider Details

I. General information

NPI: 1700804952
Provider Name (Legal Business Name): STERLING REED STEVENS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E 3RD AVE S
CAVALIER ND
58220-4023
US

IV. Provider business mailing address

202 EAST 3RD AVUNUE SOUTH
CAVALIER ND
58220
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-8777
  • Fax: 701-265-8777
Mailing address:
  • Phone: 701-265-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8777
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2100
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: