Provider Demographics
NPI:1023169216
Name:MIROSLAV M. STANIC D.D.S. INC
Entity type:Organization
Organization Name:MIROSLAV M. STANIC D.D.S. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:STANIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-635-7186
Mailing Address - Street 1:5601 W HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5136
Mailing Address - Country:US
Mailing Address - Phone:559-635-7186
Mailing Address - Fax:559-635-7188
Practice Address - Street 1:5601 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5136
Practice Address - Country:US
Practice Address - Phone:559-635-7186
Practice Address - Fax:559-635-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty