Provider Demographics
NPI:1386866317
Name:STILLMAN, JOSHUA LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LOUIS
Last Name:STILLMAN
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 1:5848 SKYWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4958
Mailing Address - Country:US
Mailing Address - Phone:530-872-5300
Mailing Address - Fax:530-872-9483
Practice Address - Street 1:5848 SKYWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4958
Practice Address - Country:US
Practice Address - Phone:530-872-5300
Practice Address - Fax:530-872-9483
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA508614OtherMEDI-CAL DENTI-CAL ID