Provider Demographics
NPI:1487314407
Name:BULL FALLS DENTAL, LLC
Entity type:Organization
Organization Name:BULL FALLS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STECKBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-410-7900
Mailing Address - Street 1:2300 WITZEL AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-1700
Mailing Address - Country:US
Mailing Address - Phone:920-235-3251
Mailing Address - Fax:
Practice Address - Street 1:211 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4411
Practice Address - Country:US
Practice Address - Phone:715-845-7154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental