Healthcare Provider Details

I. General information

NPI: 1164433447
Provider Name (Legal Business Name): ROBERT E STEVENS SR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 FM 2100
CROSBY TX
77532
US

IV. Provider business mailing address

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:
Title or Position:
Credential:
Phone: