Healthcare Provider Details

I. General information

NPI: 1982649356
Provider Name (Legal Business Name): ERIC T STOOPLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET 5 WHITE BUILDING
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 SPRUCE ST 5 WHITE BUILDING
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3580
  • Fax: 215-662-7445
Mailing address:
  • Phone: 215-662-3580
  • Fax: 215-662-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS 035317
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS035317
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: