Healthcare Provider Details

I. General information

NPI: 1124540315
Provider Name (Legal Business Name): FOX RUN DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E FRANKLIN ST
APPLETON WI
54911-5434
US

IV. Provider business mailing address

2300 WITZEL AVE
OSHKOSH WI
54904-1700
US

V. Phone/Fax

Practice location:
  • Phone: 920-235-3251
  • Fax: 920-235-3567
Mailing address:
  • Phone: 920-235-3251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WYN STECKBAUER
Title or Position: OWNER
Credential: DMD
Phone: 920-235-3251