MEDICARE: DR. JOHN ROSS STOOKSBERRY 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	1223G0001X	General Practice Dentistry	19412	TX

General Provider Information

NPI Number	:	1306849021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ROSS STOOKSBERRY DDS

Provider Business Mailing Address
First Line	:	3302 GASTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2013
Country	:	US
Telephone Number	:	972-828-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3302 GASTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2013
Country	:	US
Telephone Number	:	972-828-8100
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/24/2016

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