Provider Demographics
NPI:1003059858
Name:STEPKA FAMILY DENTAL, INC.
Entity Type:Organization
Organization Name:STEPKA FAMILY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:STEPKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-766-9857
Mailing Address - Street 1:501 GREAT RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6833
Mailing Address - Country:US
Mailing Address - Phone:401-766-9857
Mailing Address - Fax:
Practice Address - Street 1:501 GREAT RD
Practice Address - Street 2:STE. 207
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6833
Practice Address - Country:US
Practice Address - Phone:401-762-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02829261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental