Provider Demographics
NPI:1205165776
Name:STINGL, DEBRA J (RDH)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:STINGL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N 112TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4132
Mailing Address - Country:US
Mailing Address - Phone:414-322-1731
Mailing Address - Fax:414-810-1685
Practice Address - Street 1:516 N 112TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4132
Practice Address - Country:US
Practice Address - Phone:414-322-1731
Practice Address - Fax:414-810-1685
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3614-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33811500Medicaid