Mary Bernona Stevens, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12849 Issued in MI

Practice address

1172 Nixon Ave NW
Grand Rapids, MI 49544-3638

Phone

(616) 453-0644

Fax

(616) 453-0640

NPI assigned

May 23, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mary Bernona Stevens DDS, PLLC

  • Dental Clinic/Center
  • Grand Rapids, MI
  • NPI 1528678364
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003819004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 NIXON AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495343638",
            "telephone_number": "616-453-0644",
            "fax_number": "616-453-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1172 NIXON AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495443638",
            "telephone_number": "616-453-0644",
            "fax_number": "616-453-0640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "MARY",
        "middle_name": "BERNONA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "12849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Stevens, DPT
• Katherine Taylor Stevens, LLMSW
• Kevin John Stevens, D.D.S.
• Lindsey Louise Stevens, COTAL
• Mark Paul Stevens
• Maryann Stevens
• Michael Richard-Everell Stevens, MD
• Philip J Stevens, PA
• Rebecca Jo Stevens
• Sydney Stevens

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.