Healthcare Provider Details

I. General information

NPI: 1154485845
Provider Name (Legal Business Name): ROBERT E. STEVENS, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 FM2100
CROSBY TX
77532
US

IV. Provider business mailing address

5909 FM2100 P.O.BOX 488
CROSBY TX
77532
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-4846
  • Fax: 281-328-5605
Mailing address:
  • Phone: 281-328-4846
  • Fax: 281-328-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9552
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT E STEVENS SR.
Title or Position: OWNER
Credential: DDS
Phone: 281-328-4846