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General NPI Number Information
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NPI Number | 1336580786
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Entity Type | Individual
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Provider Name | FALLON L STIENS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 3524 US HIGHWAY 169
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City | STANBERRY
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State | MO
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Zip | 64489-8210
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Country | US
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Telephone | 660-783-2205
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Fax | 660-783-9021
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Provider Business Mailing Address
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Address Line | PO BOX 203 3524 US HWY 169
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City | STANBERRY
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State | MO
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Zip | 64489-0203
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Country | US
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Telephone | 660-783-2205
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Fax | 660-783-9021
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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 | 2013016353
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License Number State | MO
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