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General NPI Number Information
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NPI Number | 1992810188
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Entity Type | Individual
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Provider Name | STEVEN ROBERT PLETSCHER DDS
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 623 AVENUE OF THE CITIES RIDGEWOOD CENTER
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City | EAST MOLINE
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State | IL
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Zip | 61244-4029
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Country | US
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Telephone | 309-752-0350
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Fax | 309-752-0357
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Provider Business Mailing Address
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Address Line | 623 AVENUE OF THE CITIES RIDGEWOOD CENTER
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City | EAST MOLINE
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State | IL
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Zip | 61244-4029
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Country | US
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Telephone | 309-752-0350
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Fax | 309-752-0350
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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 | D9034
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.027599
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License Number State | IL
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