Provider Demographics
NPI:1730259540
Name:EDWARD J STEPKA JR DMD INC
Entity type:Organization
Organization Name:EDWARD J STEPKA JR DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEPKA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-766-9857
Mailing Address - Street 1:501 GREAT ROAD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NO SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896
Mailing Address - Country:US
Mailing Address - Phone:401-766-9857
Mailing Address - Fax:401-762-0871
Practice Address - Street 1:501 GREAT ROAD
Practice Address - Street 2:SUITE 207
Practice Address - City:NO SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896
Practice Address - Country:US
Practice Address - Phone:401-766-9857
Practice Address - Fax:401-762-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI16281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty