Provider Demographics
NPI:1134485857
Name:SOUSA, STEVEN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:SOUSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WINDCHIME DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2934
Mailing Address - Country:US
Mailing Address - Phone:508-339-1649
Mailing Address - Fax:
Practice Address - Street 1:26 WINDCHIME DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2934
Practice Address - Country:US
Practice Address - Phone:508-339-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN143831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice