Provider Demographics
NPI:1831248202
Name:TRAUB, STEVEN JACOB (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JACOB
Last Name:TRAUB
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 1:9915 SAN BERNARDINO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3215
Mailing Address - Country:US
Mailing Address - Phone:505-872-2691
Mailing Address - Fax:
Practice Address - Street 1:8400 OSUNA RD NE
Practice Address - Street 2:SUITE 6-B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2087
Practice Address - Country:US
Practice Address - Phone:505-292-8555
Practice Address - Fax:505-293-3863
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD12611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
827635OtherUNITED CONCORDIA (DENTAL)
NM82222Medicaid