Provider Demographics
NPI:1871718668
Name:ROBERT A STIPANOV DDS PA
Entity type:Organization
Organization Name:ROBERT A STIPANOV DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTONY
Authorized Official - Last Name:STIPANOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:941-739-8303
Mailing Address - Street 1:6060 53RD AVE E
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9719
Mailing Address - Country:US
Mailing Address - Phone:941-739-8303
Mailing Address - Fax:
Practice Address - Street 1:6060 53RD AVE E
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9719
Practice Address - Country:US
Practice Address - Phone:941-739-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00119111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty