Provider Demographics
NPI:1871717496
Name:STECKER, BRIAN C (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:STECKER
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 1:54 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8049
Mailing Address - Country:US
Mailing Address - Phone:920-923-1239
Mailing Address - Fax:920-923-5221
Practice Address - Street 1:54 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8049
Practice Address - Country:US
Practice Address - Phone:920-923-1239
Practice Address - Fax:920-923-5221
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry