Provider Demographics
NPI:1104400415
Name:STANIK, JESSICA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:STANIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2379 ASHDALE ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-6215
Mailing Address - Country:US
Mailing Address - Phone:330-205-0992
Mailing Address - Fax:
Practice Address - Street 1:1470 E VALENTINE CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3100
Practice Address - Country:US
Practice Address - Phone:330-355-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0264651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice