Provider Demographics
NPI:1992727010
Name:STEC, EDWARD J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:STEC
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:25 LAKE ST N
Mailing Address - Street 2:STE 110
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2535
Mailing Address - Country:US
Mailing Address - Phone:651-464-7388
Mailing Address - Fax:651-982-6236
Practice Address - Street 1:25 LAKE ST N
Practice Address - Street 2:STE 110
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2535
Practice Address - Country:US
Practice Address - Phone:651-464-7388
Practice Address - Fax:651-982-6236
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN99201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics