Provider Demographics
NPI:1710907258
Name:STADNYK & DRISSELL & ASSOCIATES P.C.
Entity Type:Organization
Organization Name:STADNYK & DRISSELL & ASSOCIATES P.C.
Other - Org Name:KEHRS MILL DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STADNYK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-230-7557
Mailing Address - Street 1:980 KEHRS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2402
Mailing Address - Country:US
Mailing Address - Phone:636-230-7557
Mailing Address - Fax:636-394-2895
Practice Address - Street 1:980 KEHRS MILL RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2402
Practice Address - Country:US
Practice Address - Phone:636-230-7557
Practice Address - Fax:636-394-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOD010702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty