MEDICARE: STEFAN NICHOLAS STROH 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
1	122300000X	Dentist	12337282-9922	UT
2	122300000X	Dentist	DN28722	FL

General Provider Information

NPI Number	:	1851964001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN NICHOLAS STROH DMD

Provider Business Mailing Address
First Line	:	2587 WINDWOOD LN
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-6126
Country	:	US
Telephone Number	:	904-233-4891
Fax Number	:

Provider Business Practice Location Address
First Line	:	8823 GOODBYS EXECUTIVE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4605
Country	:	US
Telephone Number	:	904-215-3182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	03/04/2024

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