MEDICARE: DR. RICHARD WAYNE STEVENS D.D.S., M.S.

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	1223E0200X	Endodontics	SC 3083	SC
2	1223E0200X	Endodontics	8731	NC

General Provider Information

NPI Number	:	1285613562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WAYNE STEVENS D.D.S., M.S.

Provider Business Mailing Address
First Line	:	4251 ARENDELL ST
Second Line	:	SUITE H
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2869
Country	:	US
Telephone Number	:	252-240-3636
Fax Number	:	252-247-2233

Provider Business Practice Location Address
First Line	:	4251 ARENDELL ST
Second Line	:	SUITE H
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2869
Country	:	US
Telephone Number	:	252-240-3636
Fax Number	:	252-247-2233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	04/21/2010

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