Stephen F Petras, DMD
Individual provider Active NPI General Practice Dentistry · Stockton, IL
NPI 1710052246 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1710052246
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 120 W Front Ave
Stockton, IL 61085-1318 - Phone
- (815) 947-3700
- Fax
- (815) 947-9058
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150825004775 | IL | Order and Referring Only - Oral Surgery |
5294041067 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stockton Dental Center, Inc. | General Practice | Past | Accepting new patients |
| Christian Triand DMD PLLC | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
120 W Front Ave
Stockton, IL 61085-1318
Mailing address
120 W Front Ave
PO Box 146
Stockton, IL 61085-1318
Phone (815) 947-3700
Other providers in Stockton, IL
- Jane Addams Community Mental Health Center
- Jennifer Johnson
- Kreider Services, Inc
- Amy Larson
- Michael J McFadden
- Pleasant Valley Chiropractic and Sports Medicine
- Premier Chiropractic PC
- Caitlin M Pullara
- Travis J Ray
- Stockton Cusd 206
All providers in Stockton, 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.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.