Healthcare Provider Details

I. General information

NPI: 1114842978
Provider Name (Legal Business Name): JOSEPH STOFFEL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 ANCHORAGE RD
WARSAW IN
46580-2281
US

IV. Provider business mailing address

1423 CYPRESS SPRING DR
FORT WAYNE IN
46814-8897
US

V. Phone/Fax

Practice location:
  • Phone: 574-549-9940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12015110A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: