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General NPI Number Information
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NPI Number | 1780889014
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Entity Type | Individual
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Provider Name | SONYA M. STOLTZE NEWSTROM D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 511 DUFF AVE STE 200
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City | AMES
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State | IA
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Zip | 50010-6391
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Country | US
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Telephone | 515-233-3797
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Fax | 515-232-0226
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Provider Business Mailing Address
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Address Line | 405 DOUGLAS AVE APT B
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City | AMES
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State | IA
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Zip | 50010-6488
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08479
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License Number State | IA
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