Healthcare Provider Details

I. General information

NPI: 1558510461
Provider Name (Legal Business Name): MICHAEL T. STECHER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S CODY RD
LE CLAIRE IA
52753-9236
US

IV. Provider business mailing address

PO BOX 814
LE CLAIRE IA
52753-0814
US

V. Phone/Fax

Practice location:
  • Phone: 563-289-3249
  • Fax:
Mailing address:
  • Phone: 563-289-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number009939
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08670
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: