Provider Demographics
NPI:1609501527
Name:DEREK STEINBACHER, MD, DMD, FACS, PLLC
Entity type:Organization
Organization Name:DEREK STEINBACHER, MD, DMD, FACS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEINBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD, FACS, FRCS
Authorized Official - Phone:617-230-8547
Mailing Address - Street 1:431 VINEYARD POINT RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3245
Mailing Address - Country:US
Mailing Address - Phone:617-230-8547
Mailing Address - Fax:
Practice Address - Street 1:5 DURHAM RD STE 1-8
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2076
Practice Address - Country:US
Practice Address - Phone:203-453-6635
Practice Address - Fax:203-458-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center