Provider Demographics
NPI:1114191061
Name:STINAUER, JESSE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:J
Last Name:STINAUER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61542-9624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:IL
Practice Address - Zip Code:61542-9624
Practice Address - Country:US
Practice Address - Phone:309-547-2200
Practice Address - Fax:309-547-2022
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0270861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice