Healthcare Provider Details

I. General information

NPI: 1003698499
Provider Name (Legal Business Name): STECKLER FAMILY DRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 LARKIN RD STE 201
LEXINGTON KY
40503-3256
US

IV. Provider business mailing address

105 SPRUCE ST
LEXINGTON KY
40507-2109
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-6009
  • Fax:
Mailing address:
  • Phone: 859-286-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAMES WHITE
Title or Position: MANAGER
Credential:
Phone: 859-533-1109