Provider Demographics
NPI:1043430721
Name:STOVALL, JOE BARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:BARRY
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 1:4900 OVERTON RIDGE BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1940
Mailing Address - Country:US
Mailing Address - Phone:817-292-5957
Mailing Address - Fax:817-292-0763
Practice Address - Street 1:4900 OVERTON RIDGE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1940
Practice Address - Country:US
Practice Address - Phone:817-292-5957
Practice Address - Fax:817-292-0763
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice