Provider Demographics
NPI:1083746242
Name:STEPHEN R. VAN ESS, D.D.S., S.C.
Entity Type:Organization
Organization Name:STEPHEN R. VAN ESS, D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:VAN ESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-626-8444
Mailing Address - Street 1:1053 FOND DU LAC AVE
Mailing Address - Street 2:P.O. BOX 559
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-9495
Mailing Address - Country:US
Mailing Address - Phone:262-626-8444
Mailing Address - Fax:
Practice Address - Street 1:1053 FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:KEWASKUM
Practice Address - State:WI
Practice Address - Zip Code:53040-9495
Practice Address - Country:US
Practice Address - Phone:262-626-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI027751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty