Provider Demographics
NPI:1336498120
Name:RICHARD DEE STOKER D.M.D., PLLC
Entity Type:Organization
Organization Name:RICHARD DEE STOKER D.M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-522-4700
Mailing Address - Street 1:3350 S 15TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8321
Mailing Address - Country:US
Mailing Address - Phone:208-522-4700
Mailing Address - Fax:208-522-5416
Practice Address - Street 1:3350 S 15TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8321
Practice Address - Country:US
Practice Address - Phone:208-522-4700
Practice Address - Fax:208-522-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty