Provider Demographics
NPI:1922578764
Name:STEVE CHILDRESS II, DDS
Entity Type:Organization
Organization Name:STEVE CHILDRESS II, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-255-0439
Mailing Address - Street 1:402 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2806
Mailing Address - Country:US
Mailing Address - Phone:304-255-0439
Mailing Address - Fax:
Practice Address - Street 1:402 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2806
Practice Address - Country:US
Practice Address - Phone:304-255-0439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1548209869Medicaid
WV1588145429OtherNATIONAL PLAN & PROVIDER ENUMERATION SERVICE