Provider Demographics
NPI:1144392457
Name:STEFFENSEN, JON ERIC
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ERIC
Last Name:STEFFENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 TRANCAS ST STE E
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3308
Mailing Address - Country:US
Mailing Address - Phone:707-255-3725
Mailing Address - Fax:
Practice Address - Street 1:1600 TRANCAS ST STE E
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3308
Practice Address - Country:US
Practice Address - Phone:707-255-3725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412171223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology