Provider Demographics
NPI:1891181343
Name:STEEL ORAL AND MAXILLOFACIAL SURGERY INC
Entity Type:Organization
Organization Name:STEEL ORAL AND MAXILLOFACIAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:STEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-372-6123
Mailing Address - Street 1:915 MESA ROJA TRL NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6388
Mailing Address - Country:US
Mailing Address - Phone:801-372-6123
Mailing Address - Fax:
Practice Address - Street 1:915 MESA ROJA TRL NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6388
Practice Address - Country:US
Practice Address - Phone:801-372-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-11
Last Update Date:2017-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4263261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental