Provider Demographics
NPI:1225584881
Name:CHRISTOPHER STANOSHECK, DDS, PC
Entity Type:Organization
Organization Name:CHRISTOPHER STANOSHECK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANOSHECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-228-7215
Mailing Address - Street 1:9525 PIACERE WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7733
Mailing Address - Country:US
Mailing Address - Phone:239-228-7215
Mailing Address - Fax:239-236-1440
Practice Address - Street 1:9525 PIACERE WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7733
Practice Address - Country:US
Practice Address - Phone:239-228-7215
Practice Address - Fax:239-236-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1649268111Medicaid
NE10025758200Medicaid