Healthcare Provider Details

I. General information

NPI: 1346498722
Provider Name (Legal Business Name): CRAIG T. STEICHEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

IV. Provider business mailing address

7131 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-6562
  • Fax: 505-883-8634
Mailing address:
  • Phone: 505-883-6562
  • Fax: 505-883-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDD1629
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1629
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: