MEDICARE: DR. STEVEN ROBERT PLETSCHER DDS

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	D9034	MN
2	122300000X	Dentist	019.027599	IL

General Provider Information

NPI Number	:	1992810188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ROBERT PLETSCHER DDS

Provider Business Mailing Address
First Line	:	623 AVENUE OF THE CITIES
Second Line	:	RIDGEWOOD CENTER
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-4029
Country	:	US
Telephone Number	:	309-752-0350
Fax Number	:	309-752-0350

Provider Business Practice Location Address
First Line	:	623 AVENUE OF THE CITIES
Second Line	:	RIDGEWOOD CENTER
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-4029
Country	:	US
Telephone Number	:	309-752-0350
Fax Number	:	309-752-0357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/20/2012

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