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General NPI Number Information
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NPI Number | 1639218944
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Entity Type | Individual
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Provider Name | JOHN EDWARD STUPARITZ DDS,MS
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 103 S GREENLEAF ST SUITE K
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City | GURNEE
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State | IL
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Zip | 60031-3380
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Country | US
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Telephone | 847-782-0048
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Fax |
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Provider Business Mailing Address
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Address Line | 921 OLD TRAIL RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-1167
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Country | US
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Telephone | 847-681-0215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021.001771
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License Number State | IL
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