Provider Demographics
NPI:1629018536
Name:STEIL, MICHAEL WALDEMAR (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WALDEMAR
Last Name:STEIL
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 1:1900 CENTRACARE CIRCLE
Mailing Address - Street 2:STE 0350
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-253-0272
Mailing Address - Fax:320-251-2661
Practice Address - Street 1:1900 CENTRACARE CIRCLE
Practice Address - Street 2:STE 0350
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-253-0272
Practice Address - Fax:320-251-2661
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP23190OtherHEALTH PARTNERS
MN54F61STOtherBLUE CROSS BLUE SHIELD
MN961322600Medicaid