Provider Demographics
NPI:1265757652
Name:STIEFEL, JOHN MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARTIN
Last Name:STIEFEL
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 1:117 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-1643
Mailing Address - Country:US
Mailing Address - Phone:419-342-2603
Mailing Address - Fax:
Practice Address - Street 1:117 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1643
Practice Address - Country:US
Practice Address - Phone:419-342-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice