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General NPI Number Information
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NPI Number | 1215138250
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Entity Type | Individual
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Provider Name | DENNIS G STODDARD DDS
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 625 E ALAMEDA RD
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City | POCATELLO
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State | ID
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Zip | 83201-3622
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Country | US
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Telephone | 208-237-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 2295 S CHAMBERS RD #E
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City | AURORA
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State | CO
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Zip | 80014-4544
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Country | US
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Telephone | 303-751-6511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8647
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8647
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D-4186-PD
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License Number State | ID
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