Provider Demographics
NPI:1255324893
Name:STOVER, ROBERT EDWARD (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:STOVER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11407 136TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2427
Mailing Address - Country:US
Mailing Address - Phone:360-456-1200
Mailing Address - Fax:360-456-0213
Practice Address - Street 1:128 LILLY RD NE STE 125
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-7400
Practice Address - Country:US
Practice Address - Phone:360-456-1200
Practice Address - Fax:360-456-0213
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64681223P0700X
WADE000109321223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics