Bryan David Stahl, DDS
Individual provider Active NPI General Practice Dentistry · Fox River Grove, IL
NPI 1154431765 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154431765
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 1109 Lincoln Ave
Fox River Grove, IL 60021 - Phone
- (847) 516-1933
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019020904 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
1109 Lincoln Ave
Fox River Grove, IL 60021
Mailing address
1109 Lincoln Ave
Fox River Grove, IL 60021
Phone (847) 516-1933
Other providers in Fox River Grove, IL
- Robert Schwartzenberg
- Second Season Adult Day Retreat
- Kyle Shively
- Sheryl Sierakowski
- Oleg Michal Simkovic
- Staicu Cardiology S.C.
- Irina Staicu
- Margaret B Stefani
- Steven P. Kipferl D.P.M. P.C.
- Sneha Tharwani
All providers in Fox River Grove, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.