Provider Demographics
NPI:1568863041
Name:STEINWEDEL, DAVID CARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARL
Last Name:STEINWEDEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 W CORNERSTONE CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2494
Mailing Address - Country:US
Mailing Address - Phone:309-693-2232
Mailing Address - Fax:
Practice Address - Street 1:2425 W CORNERSTONE CT
Practice Address - Street 2:SUITE B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2494
Practice Address - Country:US
Practice Address - Phone:309-693-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist