MEDICARE: DR. JAMES C 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	1223P0300X	Periodontics	139325	UT

General Provider Information

NPI Number	:	1518051655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES C STOVER D.D.S

Provider Business Mailing Address
First Line	:	508 E SOUTH TEMPLE
Second Line	:	114
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1013
Country	:	US
Telephone Number	:	801-322-5032
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 E SOUTH TEMPLE
Second Line	:	114
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1013
Country	:	US
Telephone Number	:	801-322-5032
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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