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NPI Code Detail

MEDICARE: ERIC STINE D.D.S., M.S.

MEDICARE: ERIC STINE D.D.S., M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)D11632MN

General Provider Information

NPI Number : 1932156387
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC STINE D.D.S., M.S.
Provider Business Mailing Address
First Line : 3950 VETERANS DR
Second Line : SUITE 100
City : SAINT CLOUD
State : MN
Zip : 56303-3410
Country : US
Telephone Number : 320-252-3611
Fax Number : 320-252-7574
Provider Business Practice Location Address
First Line : 3950 VETERANS DR
Second Line : SUITE 100
City : SAINT CLOUD
State : MN
Zip : 56303-3410
Country : US
Telephone Number : 320-252-3611
Fax Number : 320-252-7574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 07/08/2007

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1902843683 — ROBERT J KECK D.D.S., M.S.
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