Healthcare Provider Details

I. General information

NPI: 1295001501
Provider Name (Legal Business Name): JOSEPHINE STOKES, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E 22ND AVE STE E
EUGENE OR
97405-2989
US

IV. Provider business mailing address

622 E 22ND AVE STE E
EUGENE OR
97405-2989
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-3003
  • Fax:
Mailing address:
  • Phone: 541-686-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8117
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOSEPHINE LYNNE STOKES
Title or Position: OWNER
Credential: DDS
Phone: 541-686-3003