Provider Demographics
NPI:1104883974
Name:JOSEPHSON, STEVEN L (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:JOSEPHSON
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 1:363 BRANDING IRON RD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6119
Mailing Address - Country:US
Mailing Address - Phone:505-892-9485
Mailing Address - Fax:
Practice Address - Street 1:6301 4TH ST NW
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5860
Practice Address - Country:US
Practice Address - Phone:505-345-0880
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM12821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice