Individual
DR. RANDALL DAVID STASTNY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4350 MALSBARY RD, SUITE 201, BLUE ASH, OH 45242-5665
(513) 984-2100
(513) 984-2155
Mailing address
4350 MALSBARY RD, SUITE 201, BLUE ASH, OH 45242-5665
(513) 984-2100
(513) 984-2155
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
30-1-8892
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11892
HUMANA
OH
Enumeration date
07/07/2005
Last updated
03/16/2012
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