Provider Demographics
NPI:1912129503
Name:RASMUSSEN, STEPHEN W (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:RASMUSSEN
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 1:814 S. EAGLES WAY
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933
Mailing Address - Country:US
Mailing Address - Phone:765-364-0639
Mailing Address - Fax:
Practice Address - Street 1:1485 S. GRANT AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933
Practice Address - Country:US
Practice Address - Phone:765-362-0900
Practice Address - Fax:765-362-0901
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ120088171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA853111OtherUNITED CONCORDIA