MEDICARE: DR. RONALD PAUL STIFTER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5000468015	WI

General Provider Information

NPI Number	:	1275649790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD PAUL STIFTER DDS

Provider Business Mailing Address
First Line	:	2659 HAWTHORNE DR
Second Line	:
City	:	SAUKVILLE
State	:	WI
Zip	:	53080-1109
Country	:	US
Telephone Number	:	262-675-6065
Fax Number	:

Provider Business Practice Location Address
First Line	:	2659 HAWTHORNE DR
Second Line	:
City	:	SAUKVILLE
State	:	WI
Zip	:	53080-1109
Country	:	US
Telephone Number	:	262-675-6065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	06/11/2009

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