Healthcare Provider Details

I. General information

NPI: 1356308092
Provider Name (Legal Business Name): PATRICIA S. STOKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10633 GLASS TUMBLER PATH
COLUMBIA MD
21044-4146
US

IV. Provider business mailing address

6345 WOODSIDE CT SUITE 103
COLUMBIA MD
21046-3227
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-0767
  • Fax:
Mailing address:
  • Phone: 410-312-5660
  • Fax: 410-312-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: