Healthcare Provider Details

I. General information

NPI: 1114925930
Provider Name (Legal Business Name): ROBERT H. STEPHENSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COUNTRY CLUB RD
EUGENE OR
97401-6001
US

IV. Provider business mailing address

700 COUNTRY CLUB RD
EUGENE OR
97401-6001
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-8527
  • Fax: 541-349-0510
Mailing address:
  • Phone: 541-343-8527
  • Fax: 541-349-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6473
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier439516
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED CONCORDIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: