Provider Demographics
NPI:1255737151
Name:RHEEM, STEPHEN (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:RHEEM
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 1:222 KAREN AVE UNIT 4004
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-0424
Mailing Address - Country:US
Mailing Address - Phone:818-326-8464
Mailing Address - Fax:
Practice Address - Street 1:322 KAREN AVE UNIT 1201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-0424
Practice Address - Country:US
Practice Address - Phone:818-326-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6569122300000X
CADDS1014281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist