Provider Demographics
NPI:1063418416
Name:CHYBOWSKI, STEVEN R (DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:CHYBOWSKI
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 1:8375 S HOWELL AVE
Mailing Address - Street 2:#201
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8344
Mailing Address - Country:US
Mailing Address - Phone:414-768-1020
Mailing Address - Fax:414-768-8866
Practice Address - Street 1:8375 S HOWELL AVE
Practice Address - Street 2:#201
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-8344
Practice Address - Country:US
Practice Address - Phone:414-768-1020
Practice Address - Fax:414-768-8866
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38393100Medicaid
WI38393100Medicaid