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NPI Code Detail

MEDICARE: MONICA RENATE STITELER DMD

MEDICARE: MONICA RENATE STITELER DMD
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
1122300000XDentistDEN4599ME

General Provider Information

NPI Number : 1811405061
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA RENATE STITELER DMD
Provider Business Mailing Address
First Line : 401 CUMBERLAND AVE APT 701
Second Line :
City : PORTLAND
State : ME
Zip : 04101-2874
Country : US
Telephone Number : 973-960-0807
Fax Number :
Provider Business Practice Location Address
First Line : 190 PARK AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04102-2910
Country : US
Telephone Number : 207-874-1028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2018
Last Update Date : 01/22/2018

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Directions to “ MONICA RENATE STITELER DMD” Practice Location

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