Healthcare Provider Details

I. General information

NPI: 1720291040
Provider Name (Legal Business Name): DR. REESE A STEEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S MAIN ST
MARS HILL NC
28754-6273
US

IV. Provider business mailing address

831 S MAIN ST
MARS HILL NC
28754-6273
US

V. Phone/Fax

Practice location:
  • Phone: 828-689-4311
  • Fax:
Mailing address:
  • Phone: 828-689-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3835
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8998083
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: DR. REESE STEEN
Title or Position: DR
Credential:
Phone: 828-689-4311