Provider Demographics
NPI:1477593481
Name:STALL, DAVID E (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:STALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 W CHESTER PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7995
Mailing Address - Country:US
Mailing Address - Phone:610-692-8454
Mailing Address - Fax:
Practice Address - Street 1:1646 W CHESTER PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7995
Practice Address - Country:US
Practice Address - Phone:610-692-8454
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023473L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA98020OtherBC/BS PROVIDER NUMBER