Provider Demographics
NPI:1922073279
Name:SIDOFF, STEVEN LUBY SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LUBY
Last Name:SIDOFF
Suffix:SR
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 1:15811 PONDEROSA PASS
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3685
Mailing Address - Country:US
Mailing Address - Phone:847-274-2774
Mailing Address - Fax:
Practice Address - Street 1:3145 GARDEN AVE
Practice Address - Street 2:1278
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7718
Practice Address - Country:US
Practice Address - Phone:210-808-3735
Practice Address - Fax:210-808-3802
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist