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Provider Information for 1871993576

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DR. ROBERT ANTHONLY STIPANOV DDS

Gender: MALE

Individual NPI: 1871993576

Calendar   Last Updated:  2014-08-29
  Certification Date: 

Details

Name Value
NPI 1871993576
Enumeration Date 2014-08-29
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 6060 53RD AVE E SUITE B
BRADENTON, FL 34203-9719
United States

Phone: 941-739-8303 | Fax:
View Map External Link
Primary Practice Address 6060 53RD AVE E SUITE B
BRADENTON, FL 34203-9719
United States

Phone: 941-739-8303 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist FL DN11911