Provider Demographics
NPI:1598746448
Name:FENZL, STEVEN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:FENZL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 DENTAL SQ/SGD
Mailing Address - Street 2:2050A 2ND ST SE
Mailing Address - City:KIRTLAND AFB
Mailing Address - State:NM
Mailing Address - Zip Code:87117-0001
Mailing Address - Country:US
Mailing Address - Phone:505-846-2548
Mailing Address - Fax:505-846-2428
Practice Address - Street 1:377 DENTAL SQ/SGD
Practice Address - Street 2:2050A 2ND ST SE
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87117-0001
Practice Address - Country:US
Practice Address - Phone:505-846-2548
Practice Address - Fax:505-846-2428
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice