Provider Demographics
NPI:1497802789
Name:STANIC, MIROSLAV MIKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAV
Middle Name:MIKE
Last Name:STANIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5601 W HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5136
Mailing Address - Country:US
Mailing Address - Phone:559-635-7186
Mailing Address - Fax:559-635-7188
Practice Address - Street 1:5601 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5136
Practice Address - Country:US
Practice Address - Phone:559-635-7186
Practice Address - Fax:559-635-7188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372881223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies