Provider Demographics
NPI:1417918780
Name:ABBOTT, STEVEN WILLARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WILLARD
Last Name:ABBOTT
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:PO BOX 1346
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-1346
Mailing Address - Country:US
Mailing Address - Phone:541-935-2177
Mailing Address - Fax:541-935-2063
Practice Address - Street 1:25078 HUNTER RD
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-9601
Practice Address - Country:US
Practice Address - Phone:541-935-2177
Practice Address - Fax:541-935-2063
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD58721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice