Provider Demographics
NPI:1205017761
Name:GORDON J STEUCK DDS MSD INC
Entity Type:Organization
Organization Name:GORDON J STEUCK DDS MSD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:831-373-2128
Mailing Address - Street 1:1062 CASS ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4509
Mailing Address - Country:US
Mailing Address - Phone:831-373-2128
Mailing Address - Fax:831-373-5579
Practice Address - Street 1:1062 CASS ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4509
Practice Address - Country:US
Practice Address - Phone:831-373-2128
Practice Address - Fax:831-373-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty