Provider Demographics
NPI:1649487752
Name:STEPHEN W. RASMUSSEN, DDS, PC
Entity type:Organization
Organization Name:STEPHEN W. RASMUSSEN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-362-0900
Mailing Address - Street 1:1485 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-3329
Mailing Address - Country:US
Mailing Address - Phone:765-362-0900
Mailing Address - Fax:765-362-0901
Practice Address - Street 1:1485 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3329
Practice Address - Country:US
Practice Address - Phone:765-362-0900
Practice Address - Fax:765-362-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008817A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental