Healthcare Provider Details

I. General information

NPI: 1184733842
Provider Name (Legal Business Name): STEPHEN L STILLER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PAOLI PIKE
FLOYDS KNOBS IN
47119
US

IV. Provider business mailing address

3525 PAOLI PIKE PO BOX 99
FLOYDS KNOBS IN
47119
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-5930
  • Fax: 812-948-5931
Mailing address:
  • Phone: 812-948-5930
  • Fax: 812-948-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008519A
License Number StateIN

VIII. Authorized Official

Name: MR. STEPHEN L STILLER
Title or Position: PRESIDENT OWNER
Credential: DDS PC
Phone: 812-948-5930