Provider Demographics
NPI:1558411629
Name:ROBERT W STODDARD DMD PC
Entity Type:Organization
Organization Name:ROBERT W STODDARD DMD PC
Other - Org Name:ROBERT W STODDARD DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WHITTIER
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-762-1884
Mailing Address - Street 1:100 DAY STREET
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2125
Mailing Address - Country:US
Mailing Address - Phone:781-762-1884
Mailing Address - Fax:781-762-2665
Practice Address - Street 1:100 DAY STREET
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2125
Practice Address - Country:US
Practice Address - Phone:781-762-1884
Practice Address - Fax:781-762-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1679311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11599OtherBCBS OF MA