Individual
DR. JESSICA JOAN STACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1525 E 53RD ST STE 734, CHICAGO, IL 60615-4575
(773) 643-6006
Mailing address
1525 E 53RD ST STE 734, CHICAGO, IL 60615-4575
(773) 643-6006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019034433
IL
Other
Enumeration date
07/07/2023
Last updated
03/20/2024
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