Provider Demographics
NPI:1063712909
Name:FIFE, STEVEN R (DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:FIFE
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 1:2240 GRANDE BLVD SE STE 101
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1655
Mailing Address - Country:US
Mailing Address - Phone:505-994-1700
Mailing Address - Fax:
Practice Address - Street 1:2240 GRANDE BLVD SE STE 101
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1655
Practice Address - Country:US
Practice Address - Phone:505-994-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD29541223G0001X
CA456891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice