Provider Demographics
NPI:1023041316
Name:STOVALL, ORLANDO RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:RICHARD
Last Name:STOVALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2237
Mailing Address - Country:US
Mailing Address - Phone:919-735-3431
Mailing Address - Fax:919-735-3455
Practice Address - Street 1:1504 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2237
Practice Address - Country:US
Practice Address - Phone:919-735-3431
Practice Address - Fax:919-735-3455
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice