Provider Demographics
NPI:1043412372
Name:TATE, STEVEN (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:TATE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E RENFRO ST
Mailing Address - Street 2:STE 204
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3947
Mailing Address - Country:US
Mailing Address - Phone:817-295-7116
Mailing Address - Fax:817-295-1404
Practice Address - Street 1:312 E RENFRO ST
Practice Address - Street 2:STE 204
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3947
Practice Address - Country:US
Practice Address - Phone:817-295-7116
Practice Address - Fax:817-295-1404
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice