Provider Demographics
NPI:1841391109
Name:STECKBAUER, WYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WYN
Middle Name:
Last Name:STECKBAUER
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 1:2300 WITZEL AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-1700
Mailing Address - Country:US
Mailing Address - Phone:920-235-3251
Mailing Address - Fax:920-235-3567
Practice Address - Street 1:1720 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-7701
Practice Address - Country:US
Practice Address - Phone:920-235-3251
Practice Address - Fax:920-235-3567
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI46-0512852OtherTAX ID NUMBER