Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DD4659 | NM |
NPI | 1063940237 |
---|---|
Provider Name | Dr. John Steffensen |
First Address | Rio Rancho, NM 87124-2236 |
Second Address | Albuquerque, NM 87120-1204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2017 |
Last Update Date | 31/05/2017 |