MEDICARE: DR. PAMELA KATHLEEN STOVER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0401411284	VA

General Provider Information

NPI Number	:	1053411256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA KATHLEEN STOVER D.D.S.

Provider Business Mailing Address
First Line	:	1522 INSURANCE LN # B
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-7229
Country	:	US
Telephone Number	:	434-973-7744
Fax Number	:	434-975-0250

Provider Business Practice Location Address
First Line	:	1522 INSURANCE LN # B
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-7229
Country	:	US
Telephone Number	:	434-973-7744
Fax Number	:	434-975-0250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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