Healthcare Provider Details

I. General information

NPI: 1841384591
Provider Name (Legal Business Name): MUNRO STECKLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 LARKIN ROAD SUITE 201
LEXINGTON KY
40503
US

IV. Provider business mailing address

3422 GINGERTREE CIRCLE
LEXINGTON KY
40502
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-6009
  • Fax: 859-278-4443
Mailing address:
  • Phone: 859-266-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4143
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: