Provider Demographics
NPI:1962816868
Name:STINAUER, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STINAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-1140
Mailing Address - Country:US
Mailing Address - Phone:309-543-2975
Mailing Address - Fax:
Practice Address - Street 1:312 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1140
Practice Address - Country:US
Practice Address - Phone:309-543-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist