MEDICARE: DR. STEPHEN LEIGH BEVERIDGE 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	1223G0001X	General Practice Dentistry	36889	CA

General Provider Information

NPI Number	:	1750445862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN LEIGH BEVERIDGE DDS

Provider Business Mailing Address
First Line	:	3535 ROSS AVE
Second Line	:	SUITE 300
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3038
Country	:	US
Telephone Number	:	408-267-2303
Fax Number	:	408-267-5840

Provider Business Practice Location Address
First Line	:	3535 ROSS AVE
Second Line	:	SUITE 300
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3038
Country	:	US
Telephone Number	:	408-267-2303
Fax Number	:	408-267-5840

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	09/17/2019

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