Provider Demographics
NPI:1871665745
Name:STAIR, DONALD C (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:STAIR
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-0356
Mailing Address - Country:US
Mailing Address - Phone:541-935-2113
Mailing Address - Fax:
Practice Address - Street 1:25078 HUNTER AVE
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487
Practice Address - Country:US
Practice Address - Phone:541-935-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist