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General NPI Number Information
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NPI Number | 1780755520
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Entity Type | Organization
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Legal Business Name | LARIS A STUMPOS DDS PC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3950 S ROCHESTER RD SUITE 2000
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307
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Country | US
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Telephone | 248-844-8060
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Fax | 248-844-8070
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Provider Business Mailing Address
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Address Line | 3950 S ROCHESTER RD SUITE 2000
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307
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Country | US
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Telephone | 248-844-8060
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Fax | 248-844-8070
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Authorized Official
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Title or Position | OWNER
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Name | LARIS STUMPOS
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Credential | DDS
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Telephone | 248-844-8060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17720
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License Number State | MI
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