C David Stevens, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60106801 Issued in WA

Practice address

716 W Main St
Centralia, WA 98531-2847

Phone

(360) 736-0795

NPI assigned

Aug 20, 2009

Last updated

Aug 20, 2009By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Olympic Dental Center LLC

  • Dental Clinic/Center
  • Centralia, WA
  • NPI 1841318912
  NPD (past)

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250726400000",
    "number": "1417189739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1962 TROSPER RD SW",
            "address_2": "APT# O-202",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985128134",
            "telephone_number": "360-736-0795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 W MAIN ST",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985312847",
            "telephone_number": "360-736-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "C DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-20",
        "last_updated": "2009-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60106801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Star Medical Clinic Inc.
• Renate Jayne Starroff, LMHC
• Craig Merrill Stedham
• Glenn Othneil Steinhorst
• Tygh Andrew Stephens
• William Alexander Stevens, MD
• John Harvard Stiltner, DC
• Laurann Nicole Stiltner, AAC
• Jedediah Corley Stone, BA AAC
• Keana Stout, RN

• General Practice Dentistry in Centralia, WA
• Providers in Centralia, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; 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.