MEDICARE: DR. REBECCA A STOHLER DDS, MS

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	1223E0200X	Endodontics	6447	AZ
2	1223E0200X	Endodontics	50102	CA
3	1223E0200X	Endodontics	7168-15	WI

General Provider Information

NPI Number	:	1689663213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA A STOHLER DDS, MS

Provider Business Mailing Address
First Line	:	350 W GREEN TREE RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-3815
Country	:	US
Telephone Number	:	414-797-0494
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 W GREEN TREE RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-3815
Country	:	US
Telephone Number	:	414-797-0494
Fax Number	:

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	06/15/2014

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