Provider Demographics
NPI:1871767889
Name:CLINTON D. STEVENS, DDS, INC, PC
Entity type:Organization
Organization Name:CLINTON D. STEVENS, DDS, INC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:DRAKE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-587-1303
Mailing Address - Street 1:15 W 6TH ST
Mailing Address - Street 2:SUITE 1615
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-5415
Mailing Address - Country:US
Mailing Address - Phone:918-587-1303
Mailing Address - Fax:918-587-6360
Practice Address - Street 1:15 W 6TH ST
Practice Address - Street 2:SUITE 1615
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5415
Practice Address - Country:US
Practice Address - Phone:918-587-1303
Practice Address - Fax:918-587-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty