Healthcare Provider Details

I. General information

NPI: 1144248881
Provider Name (Legal Business Name): J. DENNIS STEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MAIN ST
SUSANVILLE CA
96130-4518
US

IV. Provider business mailing address

PO BOX 754
SUSANVILLE CA
96130-0754
US

V. Phone/Fax

Practice location:
  • Phone: 530-257-2020
  • Fax: 530-257-6566
Mailing address:
  • Phone: 530-257-2020
  • Fax: 530-257-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberG44348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: