Healthcare Provider Details

I. General information

NPI: 1427004340
Provider Name (Legal Business Name): STEVEN B. ROHOLT, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 MONTGOMERY BLVD NE SUITE 2-D
ALBUQUERQUE NM
87111-3670
US

IV. Provider business mailing address

10151 MONTGOMERY BLVD NE SUITE 2-D
ALBUQUERQUE NM
87111-3670
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-3400
  • Fax: 505-292-7124
Mailing address:
  • Phone: 505-292-3400
  • Fax: 505-292-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1307
License Number StateNM

VIII. Authorized Official

Name: DR. STEVEN B ROHOLT
Title or Position: PRESIDENT
Credential:
Phone: 505-292-3400