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General NPI Number Information
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NPI Number | 1861928723
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Entity Type | Organization
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Legal Business Name | STOBBE EGGETT DENTAL
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 394 S MAIN ST
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City | TOOELE
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State | UT
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Zip | 84074-2746
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Country | US
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Telephone | 435-882-2331
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Fax | 435-882-2334
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Provider Business Mailing Address
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Address Line | 394 S MAIN ST
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City | TOOELE
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State | UT
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Zip | 84074-2746
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Country | US
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Telephone | 435-882-2331
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Fax | 435-882-2334
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATHY J COX
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Credential |
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Telephone | 435-882-2331
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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 | 4923271
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License Number State | UT
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