Provider Demographics
NPI:1558667980
Name:KISHTER, STEVEN ROBERT (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROBERT
Last Name:KISHTER
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:11404 OLD GEORGETOWN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2865
Mailing Address - Country:US
Mailing Address - Phone:301-984-9111
Mailing Address - Fax:301-984-0374
Practice Address - Street 1:11404 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2865
Practice Address - Country:US
Practice Address - Phone:301-984-9111
Practice Address - Fax:301-984-0374
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD87761223S0112X
MDD0041703204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery