Provider Demographics
NPI:1205866019
Name:FERTIG, STEVEN ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLEN
Last Name:FERTIG
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 1:804 ARCANE CIR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7310
Mailing Address - Country:US
Mailing Address - Phone:252-638-2470
Mailing Address - Fax:
Practice Address - Street 1:4990 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-7514
Practice Address - Country:US
Practice Address - Phone:252-523-0544
Practice Address - Fax:252-523-4947
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice