Healthcare Provider Details

I. General information

NPI: 1831248202
Provider Name (Legal Business Name): STEVEN JACOB TRAUB D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE SUITE 6-B
ALBUQUERQUE NM
87111-2087
US

IV. Provider business mailing address

9915 SAN BERNARDINO DR NE
ALBUQUERQUE NM
87122-3215
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-8555
  • Fax: 505-293-3863
Mailing address:
  • Phone: 505-872-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD1261
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: