Healthcare Provider Details

I. General information

NPI: 1689743619
Provider Name (Legal Business Name): STEVEN M. AMATO, D.D.S., M.S., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E WALDO BLVD
MANITOWOC WI
54220-2905
US

IV. Provider business mailing address

17 E WALDO BLVD
MANITOWOC WI
54220-2905
US

V. Phone/Fax

Practice location:
  • Phone: 920-684-7103
  • Fax: 920-684-5570
Mailing address:
  • Phone: 920-684-7103
  • Fax: 920-684-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0004608
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. LINDA L ELLERMAN
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 920-684-7103