Healthcare Provider Details

I. General information

NPI: 1821183583
Provider Name (Legal Business Name): STOVER & STOVER DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 704-864-8393
  • Fax: 704-864-7312
Mailing address:
  • Phone: 704-864-8393
  • Fax: 704-864-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1059
License Number StateNC

VIII. Authorized Official

Name: DR. DOUGLAS LEE STOVER
Title or Position: PRESIDENT
Credential: DDS
Phone: 704-864-8393