Organization
SUSAN STACKER DDS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN A STACKER DDS (PRESIDENT)
(715) 845-7759
Entity
Organization
Contact information
Practice address
1220 6TH STREET, WAUSAU, WI 54403-3550
(715) 845-7759
(715) 845-4509
Mailing address
1220 6TH STREET, WAUSAU, WI 54403-3550
(715) 845-7759
(715) 845-4509
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
4828
WI
Other
Enumeration date
12/21/2006
Last updated
08/22/2020
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