Provider Demographics
NPI:1558581397
Name:STIPAK, JAMES P (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:STIPAK
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 1:4747 N HARLEM AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4652
Mailing Address - Country:US
Mailing Address - Phone:708-867-4700
Mailing Address - Fax:708-867-8107
Practice Address - Street 1:4747 N HARLEM AV
Practice Address - Street 2:SUITE D
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-4652
Practice Address - Country:US
Practice Address - Phone:708-867-4700
Practice Address - Fax:708-867-8107
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist