Individual
DONALD J. STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
2041 W ILES AVE, SUITE B, SPRINGFIELD, IL 62704-7005
(217) 546-8000
Mailing address
2041 W ILES AVE, SUITE B, SPRINGFIELD, IL 62704-7005
(217) 546-8000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
11/06/2006
Last updated
07/08/2007
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