Provider Demographics
NPI:1760495196
Name:KELLOGG, STEPHEN L (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:KELLOGG
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 1:150 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1135
Mailing Address - Country:US
Mailing Address - Phone:608-835-5727
Mailing Address - Fax:
Practice Address - Street 1:150 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1135
Practice Address - Country:US
Practice Address - Phone:608-835-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001815015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist