Provider Demographics
NPI:1316904451
Name:STINEMAN, JON DANIEL (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:DANIEL
Last Name:STINEMAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4537
Mailing Address - Country:US
Mailing Address - Phone:402-644-4452
Mailing Address - Fax:402-644-4454
Practice Address - Street 1:2304 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4537
Practice Address - Country:US
Practice Address - Phone:402-644-4452
Practice Address - Fax:402-644-4454
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83501223G0001X
NE60261223S0112X
KY7781223S0112X
OK24020204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery