Provider Demographics
NPI:1750764825
Name:STEVEN L ESSIG DDS PC
Entity type:Organization
Organization Name:STEVEN L ESSIG DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ESSIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-756-7450
Mailing Address - Street 1:33 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-1941
Mailing Address - Country:US
Mailing Address - Phone:518-756-6174
Mailing Address - Fax:518-756-8827
Practice Address - Street 1:33 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-1941
Practice Address - Country:US
Practice Address - Phone:518-756-6174
Practice Address - Fax:518-756-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30830261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00286140Medicaid