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General NPI Number Information
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NPI Number | 1558624429
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Entity Type | Individual
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Provider Name | STEPHEN JOSEPH SYRJAMAKI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2012
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 7117 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-1450
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Country | US
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Telephone | 262-942-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 S WEBSTER AVE STE 3
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City | GREEN BAY
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State | WI
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Zip | 54301-2290
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Country | US
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Telephone | 920-562-3736
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6928-15
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License Number State | WI
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