Healthcare Provider Details

I. General information

NPI: 1114571981
Provider Name (Legal Business Name): DENNIS GARTH STODDARD DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 ARBOR CREEK DR STE D3
CHARLOTTE NC
28269-0548
US

IV. Provider business mailing address

8631 ARBOR CREEK DR STE D3
CHARLOTTE NC
28269-0548
US

V. Phone/Fax

Practice location:
  • Phone: 704-875-9075
  • Fax:
Mailing address:
  • Phone: 704-875-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: KAROL MANCHOLA
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-610-5812