Healthcare Provider Details

I. General information

NPI: 1356273858
Provider Name (Legal Business Name): MARTINAS STANYS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 S KEDZIE AVE
CHICAGO IL
60632-2945
US

IV. Provider business mailing address

18W070 ROYCE BLVD APT 461
OAKBROOK TERRACE IL
60181-4920
US

V. Phone/Fax

Practice location:
  • Phone: 773-692-4290
  • Fax:
Mailing address:
  • Phone: 708-972-3684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: