Provider Demographics
NPI:1104187293
Name:STEINBACH DENTAL
Entity Type:Organization
Organization Name:STEINBACH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEINBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-781-0080
Mailing Address - Street 1:18200 W CAPITOL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1445
Mailing Address - Country:US
Mailing Address - Phone:262-781-0080
Mailing Address - Fax:
Practice Address - Street 1:18200 W CAPITOL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-1445
Practice Address - Country:US
Practice Address - Phone:262-781-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1402G122300000X
WI6882-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty