Active NPI
Richard Gray Stevenson III, D.D.S.
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1679786776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 34566
- Practice address
- 100 UCLA Medical PLZ
Suite 350
Los Angeles, CA 90095-0001 - Phone
- (310) 794-5750
- Fax
- (310) 208-0786
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34566 | CA | Primary |
Addresses
Primary practice location
100 UCLA Medical PLZ
Suite 350
Los Angeles, CA 90095-0001
Mailing address
10833 Le Conte Ave
CHS Room 33-009
Los Angeles, CA 90095-1668
Phone (310) 794-4387
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34566 | CA | MD | Licensed Psychiatric Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stevenson Dental Group | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- San Dimas, CA
- NPI 1316659709
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679786776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10833 LE CONTE AVE",
"address_2": "CHS ROOM 33-009",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900951668",
"telephone_number": "310-794-4387",
"fax_number": "310-825-2536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 UCLA MEDICAL PLZ",
"address_2": "SUITE 350",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900950001",
"telephone_number": "310-794-5750",
"fax_number": "310-208-0786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "RICHARD",
"middle_name": "GRAY",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "34566",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.