Provider Demographics
NPI:1689743619
Name:STEVEN M. AMATO, D.D.S., M.S., S.C.
Entity Type:Organization
Organization Name:STEVEN M. AMATO, D.D.S., M.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-684-7103
Mailing Address - Street 1:17 E WALDO BLVD
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2905
Mailing Address - Country:US
Mailing Address - Phone:920-684-7103
Mailing Address - Fax:920-684-5570
Practice Address - Street 1:17 E WALDO BLVD
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2905
Practice Address - Country:US
Practice Address - Phone:920-684-7103
Practice Address - Fax:920-684-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00046081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty