MEDICARE: DR. PATRICK MARSHALL STERBA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DD2524	NM
2	1223G0001X	General Practice Dentistry	6175	NE

General Provider Information

NPI Number	:	1245314921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK MARSHALL STERBA DDS

Provider Business Mailing Address
First Line	:	606 ENCINO PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2602
Country	:	US
Telephone Number	:	505-243-6714
Fax Number	:	505-243-6746

Provider Business Practice Location Address
First Line	:	606 ENCINO PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2602
Country	:	US
Telephone Number	:	505-243-6714
Fax Number	:	505-243-6746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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