Provider Demographics
NPI:1801899711
Name:WIDNER, J. STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:STEVEN
Last Name:WIDNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W 38TH ST
Mailing Address - Street 2:STE 51
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6320
Mailing Address - Country:US
Mailing Address - Phone:512-452-3223
Mailing Address - Fax:512-451-0953
Practice Address - Street 1:1500 W 38TH ST
Practice Address - Street 2:STE 51
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6320
Practice Address - Country:US
Practice Address - Phone:512-452-3223
Practice Address - Fax:512-451-0953
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2025-02-13
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TX151131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84K166Medicare UPIN