MEDICARE: STEVENS DENTAL GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235396383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENS DENTAL GROUP, PC

Provider Business Mailing Address
First Line	:	223 N MAIN ST
Second Line	:
City	:	PLENTYWOOD
State	:	MT
Zip	:	59254-1843
Country	:	US
Telephone Number	:	406-765-2700
Fax Number	:	406-765-1514

Provider Business Practice Location Address
First Line	:	223 N MAIN ST
Second Line	:
City	:	PLENTYWOOD
State	:	MT
Zip	:	59254-1843
Country	:	US
Telephone Number	:	406-765-2700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MONTE STEVENS
Credential	:	DDS
Telephone Number	:	406-765-2700

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	08/12/2010

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Directions to “STEVENS DENTAL GROUP, PC ” Practice Location

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