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General NPI Number Information
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NPI Number | 1134586571
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Entity Type | Organization
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Legal Business Name | CJ STEC DDS PC
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Dates
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Enumeration Date | 01/15/2016
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 3010 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4109
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Country | US
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Telephone | 308-382-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER STEC
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Credential | D.D.S.
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Telephone | 308-382-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7153
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License Number State | NE
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