Provider Demographics
NPI:1669572590
Name:TESCH, STEVEN RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:TESCH
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:FREDERIC
Mailing Address - State:WI
Mailing Address - Zip Code:54837-0250
Mailing Address - Country:US
Mailing Address - Phone:715-327-8607
Mailing Address - Fax:715-327-4376
Practice Address - Street 1:106 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:FREDERIC
Practice Address - State:WI
Practice Address - Zip Code:54837-0250
Practice Address - Country:US
Practice Address - Phone:715-327-8607
Practice Address - Fax:715-327-4376
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38530151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33501100Medicaid