Provider Demographics
NPI:1548371941
Name:RIMER, STEPHEN (BDS, PA)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:RIMER
Suffix:
Gender:M
Credentials:BDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MEADOWS RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2347
Mailing Address - Country:US
Mailing Address - Phone:561-368-3170
Mailing Address - Fax:561-338-6231
Practice Address - Street 1:825 MEADOWS RD
Practice Address - Street 2:SUITE 121
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2347
Practice Address - Country:US
Practice Address - Phone:561-368-3170
Practice Address - Fax:561-338-6231
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60109Medicare ID - Type Unspecified
FLT54850Medicare UPIN