Provider Demographics
NPI:1144532318
Name:STEVENS, KRISTIN (DDS)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 PARKDALE PL STE 111
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5604
Mailing Address - Country:US
Mailing Address - Phone:317-329-7170
Mailing Address - Fax:317-329-7372
Practice Address - Street 1:5873 N STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-5616
Practice Address - Country:US
Practice Address - Phone:317-548-2627
Practice Address - Fax:317-548-2305
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011445A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice