Individual provider Active NPI

Robert Dee Stevenson, D.D.S.

  • Dentist
  • Pomona, CA
National Provider Identifier
1073506150
Registry record updated Jun 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DDS36837 Issued in CA
Practice address
795 E 2ND St
Suite 8
Pomona, CA 91766-2020
Phone
(909) 706-3836
NPI assigned
Aug 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DDS36837 CA Primary

Addresses

Primary practice location

795 E 2ND St
Suite 8
Pomona, CA 91766-2020

Mailing address

795 East 2ND Street
Suite 8
Pomona, CA 91766-2020
Phone (909) 706-3836

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150713001867 CA Order and Referring Only - DentistPractitioner - Dentist 9739492240

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS36837CAMDDentist
36837CAMDPharmacotherapy Pharmacist

NPI Registry JSON

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276646400000",
    "number": "1073506150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 EAST 2ND STREET",
            "address_2": "SUITE 8",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662020",
            "telephone_number": "909-706-3836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 E 2ND ST",
            "address_2": "SUITE 8",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662020",
            "telephone_number": "909-706-3836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENSON",
        "first_name": "ROBERT",
        "middle_name": "DEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2010-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS36837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.