Provider Demographics
NPI:1902083108
Name:HARBOR ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:HARBOR ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KERWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-851-8880
Mailing Address - Street 1:5122 OLYMPIC DR NW STE B106
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1769
Mailing Address - Country:US
Mailing Address - Phone:253-851-8880
Mailing Address - Fax:253-858-2783
Practice Address - Street 1:5122 OLYMPIC DR NW STE B106
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1769
Practice Address - Country:US
Practice Address - Phone:253-851-8880
Practice Address - Fax:253-858-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0059141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty