Most Relevant Information
Provider Data
| NPI Number: | 1003819004 |
| Provider Name: | MARY BERNONA STEVENS D.D.S |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 12849 |
Most Important Dates
| Enumeration Date: | 05/23/2005 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1172 NIXON AVE NW
GRAND RAPIDS
MI
495443638
Practice Location Phone/Fax
| Phone: | 6164530644 |
| Fax: | 6164530640 |
Provider Mailing Location
1172 NIXON AVE NW
GRAND RAPIDS
MI
495343638
Provider Mailing Phone/Fax
| Phone: | 6164530644 |
| Fax: | 6164530640 |