Provider Demographics
NPI:1447348503
Name:STECK, DAVID B SR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:STECK
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:B
Other - Last Name:STECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:104 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3415
Mailing Address - Country:US
Mailing Address - Phone:740-392-5966
Mailing Address - Fax:
Practice Address - Street 1:104 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3415
Practice Address - Country:US
Practice Address - Phone:740-392-5966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0174251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0529628Medicaid
OH0529628Medicaid