Provider Demographics
NPI:1811905771
Name:STEELE, JACK DAVID (DMD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:DAVID
Last Name:STEELE
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 1:501 E POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-1151
Mailing Address - Country:US
Mailing Address - Phone:177-485-3015
Mailing Address - Fax:177-485-3096
Practice Address - Street 1:501 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-1151
Practice Address - Country:US
Practice Address - Phone:717-485-3015
Practice Address - Fax:717-485-3096
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0351441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018617750006Medicaid
PA0018617750004Medicaid