MEDICARE: STEPHEN W. RASMUSSEN, DDS, PC

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	261QD0000X	Dental Clinic/Center	12008817A	IN

General Provider Information

NPI Number	:	1649487752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN W. RASMUSSEN, DDS, PC

Provider Business Mailing Address
First Line	:	1485 S GRANT AVE
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-3329
Country	:	US
Telephone Number	:	765-362-0900
Fax Number	:	765-362-0901

Provider Business Practice Location Address
First Line	:	1485 S GRANT AVE
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-3329
Country	:	US
Telephone Number	:	765-362-0900
Fax Number	:	765-362-0901

Authorized Official
Title or Position	:	PRES-CEO
Name	:	DR. STEPHEN W. RASMUSSEN
Credential	:	D.D.S.
Telephone Number	:	765-362-0900

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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