Provider Demographics
NPI:1033243589
Name:CZECHORSKI, STEFAN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:WILLIAM
Last Name:CZECHORSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEFAN
Other - Middle Name:WILLIAM
Other - Last Name:CZECHORSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3056 HUBERTUS RD
Mailing Address - Street 2:
Mailing Address - City:HUBERTUS
Mailing Address - State:WI
Mailing Address - Zip Code:53033-9642
Mailing Address - Country:US
Mailing Address - Phone:262-628-4744
Mailing Address - Fax:
Practice Address - Street 1:3056 HUBERTUS RD
Practice Address - Street 2:
Practice Address - City:HUBERTUS
Practice Address - State:WI
Practice Address - Zip Code:53033-9642
Practice Address - Country:US
Practice Address - Phone:262-628-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5361-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice