Provider Demographics
NPI:1518376136
Name:ROADARMEL, STEPHANIE LOIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LOIS
Last Name:ROADARMEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 GRIFFIN ROAD
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277
Mailing Address - Country:US
Mailing Address - Phone:909-915-0645
Mailing Address - Fax:
Practice Address - Street 1:23RD DENTAL COMPANY / NH 29 PALMS
Practice Address - Street 2:1591 GRIFFIN ROAD
Practice Address - City:29 PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277
Practice Address - Country:US
Practice Address - Phone:760-830-7054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63662122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist