Healthcare Provider Details

I. General information

NPI: 1780930545
Provider Name (Legal Business Name): DREW STEEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 12/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MESA ROJA TRL NE
RIO RANCHO NM
87124-6388
US

IV. Provider business mailing address

915 MESA ROJA TRL NE
RIO RANCHO NM
87124-6388
US

V. Phone/Fax

Practice location:
  • Phone: 801-372-6123
  • Fax: 801-372-6123
Mailing address:
  • Phone: 801-372-6123
  • Fax: 801-372-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDRP948
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD4263
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: