Provider Demographics
NPI:1194902189
Name:REBECCA R. STEVES, DMD, PC
Entity type:Organization
Organization Name:REBECCA R. STEVES, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRUNST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-664-4011
Mailing Address - Street 1:983 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1228
Mailing Address - Country:US
Mailing Address - Phone:814-664-4011
Mailing Address - Fax:814-664-9376
Practice Address - Street 1:983 N CENTER ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1228
Practice Address - Country:US
Practice Address - Phone:814-664-4011
Practice Address - Fax:814-664-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO38747122300000X
PADSO19110L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015262710001OtherMEDICAL ASSISTANCE