Healthcare Provider Details

I. General information

NPI: 1063940237
Provider Name (Legal Business Name): JOHN STEFFENSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 COORS BLVD NW STE A
ALBUQUERQUE NM
87120-1204
US

IV. Provider business mailing address

835 BUNKER RD SE
RIO RANCHO NM
87124-2236
US

V. Phone/Fax

Practice location:
  • Phone: 505-352-1166
  • Fax:
Mailing address:
  • Phone: 505-401-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDD4659
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: