Healthcare Provider Details

I. General information

NPI: 1467419705
Provider Name (Legal Business Name): STEVEN BRIAN SCHLETTY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CASCADE ST
OSCEOLA WI
54020-0607
US

IV. Provider business mailing address

PO BOX 607
OSCEOLA WI
54020-0607
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-3303
  • Fax:
Mailing address:
  • Phone: 715-294-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5001681
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: