Healthcare Provider Details

I. General information

NPI: 1083986509
Provider Name (Legal Business Name): PATRICIA S. STOKER, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 WOODSIDE CT SUITE #103
COLUMBIA MD
21046-3227
US

IV. Provider business mailing address

6345 WOODSIDE CT SUITE #103
COLUMBIA MD
21046-3227
US

V. Phone/Fax

Practice location:
  • Phone: 410-312-5661
  • Fax: 410-312-5662
Mailing address:
  • Phone: 410-312-5661
  • Fax: 410-312-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number09046
License Number StateMD

VIII. Authorized Official

Name: DR. PATRICIA S. STOKER
Title or Position: PRESIDENT OF THE CORPORATION
Credential: D.D.S.
Phone: 410-312-5660