Healthcare Provider Details

I. General information

NPI: 1639361785
Provider Name (Legal Business Name): DANIEL JOHN STECKLER D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KY CLINIC DENTISTRY ROOM A-219
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

2505 LARKIN RD STE 201
LEXINGTON KY
40503-3256
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6261
  • Fax: 859-323-2036
Mailing address:
  • Phone: 859-278-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8386
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: