Provider Demographics
NPI:1275601940
Name:DEMILLE, STEVEN B (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:DEMILLE
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 1:2620 STEWART AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4170
Mailing Address - Country:US
Mailing Address - Phone:715-845-3171
Mailing Address - Fax:715-843-7088
Practice Address - Street 1:2620 STEWART AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4170
Practice Address - Country:US
Practice Address - Phone:715-845-3171
Practice Address - Fax:715-843-7088
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice