Provider Demographics
NPI:1033228713
Name:STINE FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:STINE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA (INACTIVE)
Authorized Official - Phone:419-626-4696
Mailing Address - Street 1:1801 E PERKINS AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-626-4696
Mailing Address - Fax:419-626-4170
Practice Address - Street 1:1801 E PERKINS AVENUE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-626-4696
Practice Address - Fax:419-626-4170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0207811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty