Susan Stacker DDS SC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

4828 Issued in WI

Legal business name

SUSAN STACKER DDS SC

Practice address

1220 6TH Street
Wausau, WI 54403-3550

Phone

(715) 845-7759

Fax

(715) 845-4509

NPI assigned

Dec 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan A Stacker, DDSNPI 1306903786

Title

President

Phone

(715) 845-7759

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan Stacker

  • Periodontics
  • Wausau, WI
  • NPI 1306903786
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497819585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 6TH STREET",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544033550",
            "telephone_number": "715-845-7759",
            "fax_number": "715-845-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 6TH STREET",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544033550",
            "telephone_number": "715-845-7759",
            "fax_number": "715-845-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN STACKER DDS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STACKER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-845-7759",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WI",
            "license": "4828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Suchomski, RN
• Alex Takashi Suginaka, D.O.
• Surgical Associates, S.C.
• Surgical Associates, SC
• Amanda Lauren Susa, OTR
• Amy L Sutheimer, DPT
• James P Sutherland Jr., MD
• Lois Swanson, LCSW
• Sweet Tooth Pediatric Dentistry, LLC
• Gary Theodore Sweet Jr., MD

• Periodontics in Wausau, WI
• Providers in Wausau, WI by specialty
• Periodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.