Healthcare Provider Details

I. General information

NPI: 1265587497
Provider Name (Legal Business Name): STEVEN K. ANDERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 8TH ST
BARABOO WI
53913-1805
US

IV. Provider business mailing address

1203 8TH ST
BARABOO WI
53913-1805
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-2112
  • Fax: 608-356-0919
Mailing address:
  • Phone: 608-356-2112
  • Fax: 608-356-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5055-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: