Provider Demographics
NPI:1386746345
Name:MATUSIK, STANLEY JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOSEPH
Last Name:MATUSIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36W171 STURGIS CT
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-9515
Mailing Address - Country:US
Mailing Address - Phone:847-428-5040
Mailing Address - Fax:
Practice Address - Street 1:200 WEST MAIN
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-1724
Practice Address - Country:US
Practice Address - Phone:847-428-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist