MEDICARE: DR. RUSSELL BRIAN STOCH DMD

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	DN8991	FL

General Provider Information

NPI Number	:	1952303869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL BRIAN STOCH DMD

Provider Business Mailing Address
First Line	:	840 US HIGHWAY 1
Second Line	:	STE 200
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3830
Country	:	US
Telephone Number	:	561-627-4040
Fax Number	:	561-624-5881

Provider Business Practice Location Address
First Line	:	840 US HIGHWAY 1
Second Line	:	STE 200
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3830
Country	:	US
Telephone Number	:	561-627-4040
Fax Number	:	561-624-5881

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	10/05/2011

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