MEDICARE: WARREN R. STENVALL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	NJ10861	NJ

General Provider Information

NPI Number	:	1598125056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN R. STENVALL LLC

Provider Business Mailing Address
First Line	:	31 BIG SPRING ROAD
Second Line	:
City	:	CALIFON
State	:	NJ
Zip	:	07830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 BIG SPRING RD
Second Line	:
City	:	CALIFON
State	:	NJ
Zip	:	07830-3427
Country	:	US
Telephone Number	:	908-975-5957
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WARREN ROBERT STENVALL
Credential	:	D.M.D
Telephone Number	:	973-214-2512

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	02/26/2016

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