MEDICARE: FOX RUN DENTAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1124540315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX RUN DENTAL, LLC

Provider Business Mailing Address
First Line	:	2300 WITZEL AVE
Second Line	:
City	:	OSHKOSH
State	:	WI
Zip	:	54904-1700
Country	:	US
Telephone Number	:	920-235-3251
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 E FRANKLIN ST
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-5434
Country	:	US
Telephone Number	:	920-235-3251
Fax Number	:	920-235-3567

Authorized Official
Title or Position	:	OWNER
Name	:	WYN STECKBAUER
Credential	:	DMD
Telephone Number	:	920-235-3251

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	10/18/2023

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