Provider Demographics
NPI:1851414312
Name:STEFFEN, MICHAEL RAYMOND (DMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:STEFFEN
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 1:302 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-663-7928
Mailing Address - Fax:918-742-6666
Practice Address - Street 1:4835 S FULTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6995
Practice Address - Country:US
Practice Address - Phone:918-663-7928
Practice Address - Fax:918-663-0633
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist