Healthcare Provider Details

I. General information

NPI: 1154468700
Provider Name (Legal Business Name): EDWIN D STEFFY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST N-7
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST N-7
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-6117
  • Fax: 505-820-6140
Mailing address:
  • Phone: 505-820-6117
  • Fax: 505-820-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD1588
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: