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General NPI Number Information
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NPI Number | 1295395507
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Entity Type | Individual
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Provider Name | RYAN MICHAEL STUKENBERG DMD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 1125 STEPHENSON LN
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City | WAUNAKEE
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State | WI
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Zip | 53597-2516
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Country | US
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Telephone | 608-849-4424
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Fax |
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Provider Business Mailing Address
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Address Line | 2590 NORWICH ST
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City | FITCHBURG
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State | WI
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Zip | 53711-5448
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Country | US
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Telephone | 815-291-7831
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1002122-15
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License Number State | WI
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