Provider Demographics
NPI:1699879908
Name:MENKE, STEPHEN J (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:MENKE
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 1:1530 S RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-624-5797
Mailing Address - Fax:417-624-2582
Practice Address - Street 1:1530 S RANGELINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-624-5797
Practice Address - Fax:417-624-2582
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist