MEDICARE: CLINTON D. STEVENS, DDS, INC, 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	5979	OK

General Provider Information

NPI Number	:	1871767889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON D. STEVENS, DDS, INC, PC

Provider Business Mailing Address
First Line	:	15 W 6TH ST
Second Line	:	SUITE 1615
City	:	TULSA
State	:	OK
Zip	:	74119-5415
Country	:	US
Telephone Number	:	918-587-1303
Fax Number	:	918-587-6360

Provider Business Practice Location Address
First Line	:	15 W 6TH ST
Second Line	:	SUITE 1615
City	:	TULSA
State	:	OK
Zip	:	74119-5415
Country	:	US
Telephone Number	:	918-587-1303
Fax Number	:	918-587-6360

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLINTON DRAKE STEVENS
Credential	:	D.D.S.
Telephone Number	:	918-587-1303

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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