Provider Demographics
NPI:1164574323
Name:KLUG, STEPHAN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:WILLIAM
Last Name:KLUG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 W GLEN OAKS LANE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:262-241-4440
Mailing Address - Fax:262-241-3331
Practice Address - Street 1:1017 W GLEN OAKS LANE
Practice Address - Street 2:SUITE 211
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-241-4440
Practice Address - Fax:262-241-3331
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist