Healthcare Provider Details

I. General information

NPI: 1568432409
Provider Name (Legal Business Name): CHAD STEPHENSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 NE GREENWOOD AVE STE 100
BEND OR
97701-4616
US

IV. Provider business mailing address

409 NE GREENWOOD AVE STE 100
BEND OR
97701-4616
US

V. Phone/Fax

Practice location:
  • Phone: 541-318-1564
  • Fax:
Mailing address:
  • Phone: 541-318-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8581
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: