Individual
DR. KEVIN RALPH STANICH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7265 PORTAGE ST NW, SUITE A, MASSILLON, OH 44646-7826
(330) 498-9730
(330) 498-9753
Mailing address
7265 PORTAGE ST NW, SUITE A, MASSILLON, OH 44646-7826
(330) 498-9730
(330) 498-9753
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21036
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030446553031
—
OH
05
—
2414051
—
OH
Enumeration date
07/15/2005
Last updated
07/09/2007
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