Provider Demographics
NPI:1851705651
Name:STECKLEIN, ZACHARY (DDS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:STECKLEIN
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 1:120 E FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1705
Mailing Address - Country:US
Mailing Address - Phone:563-927-4746
Mailing Address - Fax:563-927-6217
Practice Address - Street 1:120 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1705
Practice Address - Country:US
Practice Address - Phone:563-927-4746
Practice Address - Fax:563-927-6217
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA122300000XMedicaid