DR. SUSAN STACKER (NPI# 1306903786) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306903786 |
| Entity Type | Individual |
| Full Name | DR. SUSAN STACKER |
| Practice Address |
1220 N 6 Street Wausau WI 54401-1220 |
| Mailing Address |
1220 N 6 Street Wausau WI 54403-1220 |
| Practice Telephone | 7158457759 |
| Practice Fax Number | 7158454509 |
| Mailing Telephone | 7158457759 |
| Mailing Fax Number | 7158454509 |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2014-03-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
4828 | WI | Dental Providers |
| N | 1223P0300X |
Dentist Specialization: Periodontics |
4828 | IL | Dental Providers |
| Street Address |
1220 N 6 STREET |
| City | WAUSAU |
| State | WI |
| Zip Code | 54401-1220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164031464 | Central Wisconsin Endodontic Specialists LLC | Dentist | 2606 Stewart Avenue, #102, Wausau, WI 54401 | 2020-07-23 |
| 1376161976 | Family Foot and Ankle Clinic LLC | Podiatrist | 1901 Westwood Boulevard, Wausau, WI 54401 | 2020-07-09 |
| 1336701895 | Amy Kluetz | Counselor | 3000 Westhill Drive, Suite 100, Wausau, WI 54401 | 2019-07-05 |
| 1437640877 | Joseph T Fitz | Student in an Organized Health Care Education/Training Program | Aspirus Wausau Family Medicine, 425 Wind Ridge Drive, Wausau, WI 54401 | 2018-05-22 |
| 1699293241 | Amanda Nedd | Dietitian, Registered | 425 Pine Ridge Boulevard Suite 220 C, Wausau, WI 54401 | 2017-09-05 |
| 1396287447 | Dee Cha | Nurse Anesthetist, Certified Registered | 4851 Rachel Ln Apt 5, Wausau, WI 54401 | 2016-11-07 |
| 1013389618 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 2727 Plaza Dr., Wausau, WI 54401 | 2015-10-22 |
| 1881091163 | Judy Lao | Dental Hygienist | 413 North 17th Avenue, Wausau, WI 54401 | 2014-12-02 |
| 1295012011 | Allison Waraksa | Pharmacist | 504 S. 17th Ave, Wausau, WI 54401 | 2011-11-08 |
| 1881974053 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 504 S 17th Ave, Wausau, WI 54401 | 2011-08-19 |
| Find all providers in zip 54401 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497819585 | Susan Stacker Dds Sc | Dentist | 1220 6th Street, Wausau, WI 54403-3550 | 2006-12-21 |
| 1033211743 | Paul Scott Lewis | Dentist | 2620 Stewart Ave, Suite 216, Wausau, WI 54401-4170 | 2006-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235683830 | Phillip Crum | Dentist | 2581 Development Dr Ste 204, Bellevue, WI 54311-4248 | 2016-08-11 |
| 1285937557 | Craig William Byers | Dentist | 2457 North Mayfair Road, Suite 102, Wauwatosa, WI 53226-1405 | 2010-12-08 |
| 1558662387 | Jason William Cooke | Dentist | 2557b E Calumet St, Appleton, WI 54915-4748 | 2010-11-10 |
| 1780998997 | Thomas C. Kelley Dds Msd LLC | Dentist | 17280 W North Ave Ste 203, Brookfield, WI 53045-4366 | 2010-07-29 |
| 1376789933 | Shoreline Periodontics Limited | Dentist | 2808 Kohler Memorial Dr, Suite 2, Sheboygan, WI 53081-3177 | 2008-12-31 |
| 1003052895 | James P. Herman | Dentist | 5624 S Bonnie Ln, Hales Corners, WI 53130-1674 | 2008-12-28 |
| 1760684930 | Jeffrey Joseph Burke | Dentist | 2323 S 109th St Ste 275, West Allis, WI 53227-1912 | 2007-06-01 |
| 1992915276 | Scott George Metskas | Dentist | 3364 Iris Ln, Stevens Point, WI 54481-5618 | 2007-05-23 |
| 1134339500 | Fox River Periodontics Sc | Dentist | 2557b East Calumet St, Appleton, WI 54915 | 2007-05-23 |
| 1891903043 | Denise Y Shih | Dentist | 2853 N Marietta Ave, Milwaukee, WI 53211-3420 | 2007-05-20 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. SUSAN STACKER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.