Provider Demographics
NPI:1851740518
Name:STACHE, RUTGER WOLFGANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUTGER
Middle Name:WOLFGANG
Last Name:STACHE
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 1:350 N CLARK ST FL 6
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4712
Mailing Address - Country:US
Mailing Address - Phone:312-274-4520
Mailing Address - Fax:312-803-1869
Practice Address - Street 1:8301 S HOLLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-1303
Practice Address - Country:US
Practice Address - Phone:773-488-2444
Practice Address - Fax:773-996-3167
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist