Provider Demographics
NPI:1376762476
Name:STOECKL FAMILY DENTISTRY, SC
Entity Type:Organization
Organization Name:STOECKL FAMILY DENTISTRY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEMENS
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:STOECKL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-532-0022
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:262-532-0022
Mailing Address - Fax:262-532-0422
Practice Address - Street 1:W175N11120 STONEWOOD DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6511
Practice Address - Country:US
Practice Address - Phone:262-532-0022
Practice Address - Fax:262-532-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001195-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty