Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 24117 | TX |
NPI | 1124275011 |
---|---|
Provider Name | Dr. Matthew Ryan Steffer |
First Address | Dallas, TX 75238-3542 |
Second Address | Dallas, TX 75246-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2008 |
Last Update Date | 13/01/2009 |