Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 30.026465 | OH |
NPI | 1104400415 |
---|---|
Provider Name | Jessica Stanik |
First Address | North Canton, OH 44720-6215 |
Second Address | Massillon, OH 44646-3721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2021 |
Last Update Date | 12/05/2021 |