Healthcare Provider Details

I. General information

NPI: 1750371415
Provider Name (Legal Business Name): STEVEN L ESSIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MAIN ST
RAVENA NY
12143-1928
US

IV. Provider business mailing address

33 MAIN ST
RAVENA NY
12143-1928
US

V. Phone/Fax

Practice location:
  • Phone: 518-756-7450
  • Fax: 518-756-8827
Mailing address:
  • Phone: 518-756-7450
  • Fax: 518-756-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number030830
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: