Provider Demographics
NPI:1326043449
Name:STOVALL, RICHARD LOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOY
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 1:4151 17 MILE RD
Mailing Address - Street 2:STE F
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6866
Mailing Address - Country:US
Mailing Address - Phone:586-979-3200
Mailing Address - Fax:
Practice Address - Street 1:4151 17 MILE RD
Practice Address - Street 2:STE F
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6866
Practice Address - Country:US
Practice Address - Phone:586-979-3200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-05-03
Provider Licenses
StateLicense IDTaxonomies
MI103671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice