Provider Demographics
NPI:1639218944
Name:STUPARITZ, JOHN EDWARD (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:STUPARITZ
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 OLD TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1167
Mailing Address - Country:US
Mailing Address - Phone:847-681-0215
Mailing Address - Fax:
Practice Address - Street 1:103 S GREENLEAF ST
Practice Address - Street 2:SUITE K
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3380
Practice Address - Country:US
Practice Address - Phone:847-782-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0017711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics