Healthcare Provider Details

I. General information

NPI: 1467546085
Provider Name (Legal Business Name): DAVID EUGENE STAMOS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4731 S COCHISE SUITE 221
INDEPENDENCE MO
64055
US

IV. Provider business mailing address

3320 SADDLE RIDGE CT.
INDEPENDENCE MO
64057
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-8895
  • Fax:
Mailing address:
  • Phone: 816-224-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number013932
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: