Provider Demographics
NPI:1255393237
Name:STEINBECK, FREDERICK (DMD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:STEINBECK
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 1:627 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1727
Mailing Address - Country:US
Mailing Address - Phone:859-781-0500
Mailing Address - Fax:859-781-1151
Practice Address - Street 1:627 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1727
Practice Address - Country:US
Practice Address - Phone:859-781-0500
Practice Address - Fax:859-781-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-018163122300000X, 1223S0112X
OH30018163204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
64062227OtherOWEL
ST0615642OtherOHME
64062227OtherOWEL