Provider Demographics
NPI:1689708737
Name:ADONIS, STACIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:
Last Name:ADONIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 W WHITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6544
Mailing Address - Country:US
Mailing Address - Phone:217-793-8899
Mailing Address - Fax:217-793-9662
Practice Address - Street 1:2943 W WHITE OAKS DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6544
Practice Address - Country:US
Practice Address - Phone:217-793-8899
Practice Address - Fax:217-793-9662
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist