Healthcare Provider Details

I. General information

NPI: 1114992757
Provider Name (Legal Business Name): JOHN PAUL STELLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 ST LOUIS AVE
FT WORTH TX
76104
US

IV. Provider business mailing address

1625 ST LOUIS AVE
FT WORTH TX
76104
US

V. Phone/Fax

Practice location:
  • Phone: 817-927-1325
  • Fax: 817-927-1497
Mailing address:
  • Phone: 817-927-1325
  • Fax: 817-927-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: