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Individual

DR. JEFFREY DAVID STALEY-HENNE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
701 S MAIN ST, PARIS, IL 61944-2329
(217) 463-4155
(217) 463-4156
Mailing address
1281 N 2200TH ST, PARIS, IL 61944-6075
(217) 275-3587

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9179723
IL
Enumeration date
11/16/2005
Last updated
07/08/2007
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