Healthcare Provider Details

I. General information

NPI: 1306806500
Provider Name (Legal Business Name): VANESA T STILLMAN D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 DAY BRIDGE PL
ELLENTON FL
34222-7236
US

IV. Provider business mailing address

4151 DAY BRIDGE PL
ELLENTON FL
34222-7236
US

V. Phone/Fax

Practice location:
  • Phone: 941-527-6284
  • Fax: 941-518-0917
Mailing address:
  • Phone: 941-527-6284
  • Fax: 941-518-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN16130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: