Provider Demographics
NPI:1215927033
Name:EISEN, STEVEN E (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:EISEN
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 1:39 HOME ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3248
Mailing Address - Country:US
Mailing Address - Phone:781-395-5545
Mailing Address - Fax:781-396-6935
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-395-5545
Practice Address - Fax:781-396-6935
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice