Provider Demographics
NPI:1568513505
Name:STEEN, REESE A
Entity Type:Individual
Prefix:DR
First Name:REESE
Middle Name:A
Last Name:STEEN
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 1:831 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-6273
Mailing Address - Country:US
Mailing Address - Phone:828-689-4311
Mailing Address - Fax:828-689-3763
Practice Address - Street 1:831 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-6273
Practice Address - Country:US
Practice Address - Phone:828-689-4311
Practice Address - Fax:828-689-3763
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998083Medicaid
NC8998083Medicaid