Provider Demographics
NPI:1376676379
Name:JOHN F. STASIK, DMD, PC
Entity Type:Organization
Organization Name:JOHN F. STASIK, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:STASIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-639-5511
Mailing Address - Street 1:4583 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4905
Mailing Address - Country:US
Mailing Address - Phone:215-639-5511
Mailing Address - Fax:
Practice Address - Street 1:4583 GARLAND RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4905
Practice Address - Country:US
Practice Address - Phone:215-639-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS014692L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty