Provider Demographics
NPI:1184817645
Name:STAIB, ROBERT VINCENT (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:VINCENT
Last Name:STAIB
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 1:1430 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4830
Mailing Address - Country:US
Mailing Address - Phone:847-259-2461
Mailing Address - Fax:847-259-2461
Practice Address - Street 1:1430 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4830
Practice Address - Country:US
Practice Address - Phone:847-259-2461
Practice Address - Fax:847-259-2461
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist