Provider Demographics
NPI:1205004660
Name:STIFTER, PATRICIA
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:STIFTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-3041
Mailing Address - Country:US
Mailing Address - Phone:708-361-0662
Mailing Address - Fax:708-361-0662
Practice Address - Street 1:8100 W 119TH ST
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-3041
Practice Address - Country:US
Practice Address - Phone:708-361-0662
Practice Address - Fax:708-361-0662
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190192291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice