Provider Demographics
NPI:1710052246
Name:PETRAS, STEPHEN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:PETRAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W FRONT AVE
Mailing Address - Street 2:PO BOX 146
Mailing Address - City:STOCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61085-1318
Mailing Address - Country:US
Mailing Address - Phone:815-947-3700
Mailing Address - Fax:815-947-9058
Practice Address - Street 1:120 W FRONT AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:IL
Practice Address - Zip Code:61085-1318
Practice Address - Country:US
Practice Address - Phone:815-947-3700
Practice Address - Fax:815-947-9058
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice