Provider Demographics
NPI:1053339671
Name:STYSKAL, STEPHEN R (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:STYSKAL
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 1:6912 75TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6332
Mailing Address - Country:US
Mailing Address - Phone:253-589-1011
Mailing Address - Fax:
Practice Address - Street 1:8404 83RD AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6077
Practice Address - Country:US
Practice Address - Phone:253-588-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000078541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice