Provider Demographics
NPI:1215088968
Name:STEVEN W FAWKS DDS PC
Entity type:Organization
Organization Name:STEVEN W FAWKS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:FAWKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-776-7134
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085
Mailing Address - Country:US
Mailing Address - Phone:816-776-7134
Mailing Address - Fax:816-470-5191
Practice Address - Street 1:205 S SPARTAN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085
Practice Address - Country:US
Practice Address - Phone:816-776-7134
Practice Address - Fax:816-470-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO131011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty