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General NPI Number Information
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NPI Number | 1598822074
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Entity Type | Organization
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Legal Business Name | R M STAGER DMD & J R COOLE DMD STAGER & COOLE DENTISTRY
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 17 NORTH MAIN STREET
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City | MANSFIELD
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State | PA
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Zip | 16933
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Country | US
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Telephone | 570-662-2886
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Fax | 570-513-0585
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Provider Business Mailing Address
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Address Line | 17 NORTH MAIN STREET
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City | MANSFIELD
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State | PA
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Zip | 16933
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Country | US
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Telephone | 570-662-2886
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Fax | 570-513-0585
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Authorized Official
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Title or Position | DENTIST PARTNER
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Name | DR. ROGER MARK STAGER
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Credential | DMD
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Telephone | 570-662-2886
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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 | DS030574L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS020654L
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License Number State | PA
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