Provider Demographics
NPI:1609015494
Name:STEVENS, CLARKE J (DDS MS)
Entity type:Individual
Prefix:
First Name:CLARKE
Middle Name:J
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14441 DUPONT CT
Mailing Address - Street 2:SUITE # 301
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2153
Mailing Address - Country:US
Mailing Address - Phone:402-334-7339
Mailing Address - Fax:402-334-5620
Practice Address - Street 1:14441 DUPONT CT
Practice Address - Street 2:SUITE # 301
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2153
Practice Address - Country:US
Practice Address - Phone:402-334-7339
Practice Address - Fax:402-334-5620
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE45751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics