Healthcare Provider Details

I. General information

NPI: 1922433788
Provider Name (Legal Business Name): JAMES EDWARD STODDARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EL DORADO ST
MONTEREY CA
93940-4645
US

IV. Provider business mailing address

333 EL DORADO ST
MONTEREY CA
93940-4645
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-3068
  • Fax:
Mailing address:
  • Phone: 831-373-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberCA102418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: