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General NPI Number Information
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NPI Number | 1780929984
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Entity Type | Organization
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Legal Business Name | STOOKSBERRY FAMILY DENTAL P.C.
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 153 KENNEDY DR
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City | MARTIN
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State | TN
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Zip | 38237-3309
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Country | US
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Telephone | 731-587-9670
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Fax | 731-281-4544
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Provider Business Mailing Address
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Address Line | 153 KENNEDY DR
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City | MARTIN
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State | TN
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Zip | 38237-3309
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Country | US
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Telephone | 731-587-9670
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Fax | 731-281-4544
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICK MICHAEL STOOKSBERRY
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Credential | D.D.S.
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Telephone | 731-587-9670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8602
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License Number State | TN
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