Provider Demographics
NPI:1649268111
Name:STANOSHECK, CHRISTOPHER A (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:STANOSHECK
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 1:9202 W DODGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3343
Mailing Address - Country:US
Mailing Address - Phone:402-884-1607
Mailing Address - Fax:402-933-9065
Practice Address - Street 1:9202 W DODGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3343
Practice Address - Country:US
Practice Address - Phone:402-884-1607
Practice Address - Fax:402-933-9065
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025227100Medicaid
NE05284OtherBCBS PROVIDER NUMBER