Provider Demographics
NPI:1750993986
Name:STEPHEN R. WISSLER, DDS,PC
Entity type:Organization
Organization Name:STEPHEN R. WISSLER, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:WISSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-226-9599
Mailing Address - Street 1:1055 W FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:906-228-2733
Practice Address - Street 1:1055 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2665
Practice Address - Country:US
Practice Address - Phone:906-226-9599
Practice Address - Fax:906-228-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental