Provider Demographics
NPI:1740284306
Name:VAN ESS, STEPHEN REYNOLDS (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:REYNOLDS
Last Name:VAN ESS
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 1:1053 FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-9495
Mailing Address - Country:US
Mailing Address - Phone:262-626-8444
Mailing Address - Fax:262-626-8260
Practice Address - Street 1:1053 FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:KEWASKUM
Practice Address - State:WI
Practice Address - Zip Code:53040-9495
Practice Address - Country:US
Practice Address - Phone:262-626-8444
Practice Address - Fax:262-626-8260
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI027751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice