Healthcare Provider Details

I. General information

NPI: 1366841793
Provider Name (Legal Business Name): NOEL G STOKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 HERNDON AVE STE 102
CLOVIS CA
93612-0504
US

IV. Provider business mailing address

416 W INDIO LN
CLOVIS CA
93619-0413
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-5270
  • Fax:
Mailing address:
  • Phone: 559-392-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: