Provider Demographics
NPI:1902588288
Name:STEVENSON, STEPHANY PAPADEMETRIOU (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:PAPADEMETRIOU
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17713 N JUANITA LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7582
Mailing Address - Country:US
Mailing Address - Phone:602-292-9015
Mailing Address - Fax:
Practice Address - Street 1:6611 DEBARR RD STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1796
Practice Address - Country:US
Practice Address - Phone:844-972-4390
Practice Address - Fax:907-337-6086
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK211830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist