MEDICARE: CLIFFORD J STEINLE III D.D.S. INC.

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	1223G0001X	General Practice Dentistry	30019003	OH

General Provider Information

NPI Number	:	1720120090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD J STEINLE III D.D.S. INC.

Provider Business Mailing Address
First Line	:	212 S SOUTH ST
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2218
Country	:	US
Telephone Number	:	937-382-2212
Fax Number	:	937-382-7212

Provider Business Practice Location Address
First Line	:	212 S SOUTH ST
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2218
Country	:	US
Telephone Number	:	937-382-2212
Fax Number	:	937-382-7212

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLIFFORD JOHN STEINLE III
Credential	:	D.D.S.
Telephone Number	:	937-382-2212

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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