MEDICARE: MR. WILLIAM CRISMAN STEVENSON DDS

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	122300000X	Dentist	30666	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30666	OTHER	CA	CA DENTAL BOARD

General Provider Information

NPI Number	:	1467469213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CRISMAN STEVENSON DDS

Provider Business Mailing Address
First Line	:	3809 PLAZA DR
Second Line	:	SUITE 102
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4625
Country	:	US
Telephone Number	:	760-631-6302
Fax Number	:	760-631-1682

Provider Business Practice Location Address
First Line	:	3809 PLAZA DR
Second Line	:	SUITE 102
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4625
Country	:	US
Telephone Number	:	760-631-6302
Fax Number	:	760-631-1682

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	03/07/2023

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