NPIMap

Organization Active NPI

Robert O Stevens DMD, PA

  • Dental Clinic/Center
  • Boise, ID
National Provider Identifier
1336220144
Registry record updated May 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D1807 Issued in ID
Legal business name
ROBERT O STEVENS DMD, PA
Practice address
10572 W Business Park LN
Boise, ID 83709-6797
Phone
(208) 375-5656
Fax
(208) 375-5928
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2013

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

Authorized official

Name
Dr. Robert Orlo StevensNPI 1659717916
Title
Dentist Owner
Phone
(208) 375-5656

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X D1807 ID Primary

Addresses

Primary practice location

10572 W Business Park LN
Boise, ID 83709-6797

Mailing address

10572 W Business Park LN
Boise, ID 83709-6797
Phone (208) 375-5656

Other identifiers 2

IdentifierTypeStateIssuer
43162OtherIDREGENCE BLUE SHIELD
64709OtherIDBLUE CROSS

Other names 1

  • Bethel Dental Group Former legal business name

National Provider Directory

National Provider Directory

Locations

10572 W Business Park Ln
Boise, ID 83709
Phone (208) 375-5656

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368403200000",
    "number": "1336220144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10572 W BUSINESS PARK LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837096797",
            "telephone_number": "208-375-5656",
            "fax_number": "208-375-5928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10572 W BUSINESS PARK LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837096797",
            "telephone_number": "208-375-5656",
            "fax_number": "208-375-5928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT O STEVENS DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2013-05-13",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ORLO",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "208-375-5656",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D1807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "43162",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "64709",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethel Dental Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.