Provider Demographics
NPI:1811041510
Name:STUPNITSKY, WALTER V (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:V
Last Name:STUPNITSKY
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 1:3484 N. MILWAUKEE AVE.
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:847-299-5353
Mailing Address - Fax:847-299-5210
Practice Address - Street 1:3484 N. MILWAUKEE AVE.
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:847-299-5353
Practice Address - Fax:847-299-5210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice