Provider Demographics
NPI:1336158948
Name:STANCHINA, RICHARD ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:STANCHINA
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 1:1250 WILSON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4454
Mailing Address - Country:US
Mailing Address - Phone:906-228-7173
Mailing Address - Fax:906-228-2916
Practice Address - Street 1:1250 WILSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4454
Practice Address - Country:US
Practice Address - Phone:906-228-7173
Practice Address - Fax:906-228-2916
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJ141451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4726184Medicaid