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General NPI Number Information
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NPI Number | 1770211443
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Entity Type | Individual
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Provider Name | ELLIE M STODDART
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Gender | Female
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 3802 PAXTON AVE STE 12A
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City | CINCINNATI
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State | OH
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Zip | 45209-2399
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Country | US
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Telephone | 513-898-1194
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Fax |
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Provider Business Mailing Address
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Address Line | 701 NAPA VALLEY LN
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-5115
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Country | US
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Telephone |
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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 | 10765
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License Number State | KY
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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 | 30.026980
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License Number State | OH
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