MEDICARE: JOHN PAUL STELLA DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	15825	TX

General Provider Information

NPI Number	:	1114992757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PAUL STELLA DDS

Provider Business Mailing Address
First Line	:	1625 ST LOUIS AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104
Country	:	US
Telephone Number	:	817-927-1325
Fax Number	:	817-927-1497

Provider Business Practice Location Address
First Line	:	1625 ST LOUIS AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104
Country	:	US
Telephone Number	:	817-927-1325
Fax Number	:	817-927-1497

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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Directions to “ JOHN PAUL STELLA DDS” Practice Location

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