Healthcare Provider Details

I. General information

NPI: 1083005540
Provider Name (Legal Business Name): DAISY N STOJANOV BDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23250 MERCANTILE RD STE 110N
BEACHWOOD OH
44122-5928
US

IV. Provider business mailing address

23250 MERCANTILE RD, SUITE 110N
BEACHWOOD OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-577-0319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30.025210
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES3522
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: