Provider Demographics
NPI:1902889470
Name:STEVENS, ROGER LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEWIS
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2859
Mailing Address - Country:US
Mailing Address - Phone:785-539-2314
Mailing Address - Fax:785-539-1121
Practice Address - Street 1:1110 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2859
Practice Address - Country:US
Practice Address - Phone:785-539-2314
Practice Address - Fax:785-539-1121
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice