Healthcare Provider Details

I. General information

NPI: 1184004319
Provider Name (Legal Business Name): JENNA STOVER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 E GARRISON BLVD SUITE A
GASTONIA NC
28054-5144
US

IV. Provider business mailing address

2019 SOUTHRIDGE DR
BELMONT NC
28012-7541
US

V. Phone/Fax

Practice location:
  • Phone: 704-864-8393
  • Fax:
Mailing address:
  • Phone: 704-842-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10071
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: