Healthcare Provider Details

I. General information

NPI: 1255574778
Provider Name (Legal Business Name): STEVEN DAVID APFELBAUM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW WALL ST. SUITE 102
BEND OR
97701
US

IV. Provider business mailing address

1201 NW WALL ST. SUITE 102
BEND OR
97701
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-5080
  • Fax:
Mailing address:
  • Phone: 541-382-5080
  • Fax: 541-382-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6705
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: