Individual
STACEY TATRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
11043 BROADWAY STE A, CROWN POINT, IN 46307-8834
(219) 663-4200
Mailing address
11043 BROADWAY STE A, CROWN POINT, IN 46307-8834
(219) 663-4200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
091.030688
IL
122300000X
Dentist
Primary
12013335A
IN
Other
Enumeration date
07/11/2016
Last updated
12/16/2020
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