Provider Demographics
NPI:1457699902
Name:STASIK, JOHN FRANK (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANK
Last Name:STASIK
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 1:4583 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4905
Mailing Address - Country:US
Mailing Address - Phone:215-639-5511
Mailing Address - Fax:215-639-1563
Practice Address - Street 1:4583 GARLAND RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4905
Practice Address - Country:US
Practice Address - Phone:215-639-5511
Practice Address - Fax:215-639-1563
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS014692L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery