Provider Demographics
NPI:1558447458
Name:STAHL, JOHN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:STAHL
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 1:42 SEABURY AVE
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1343
Mailing Address - Country:US
Mailing Address - Phone:860-464-6534
Mailing Address - Fax:
Practice Address - Street 1:317 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1711
Practice Address - Country:US
Practice Address - Phone:860-739-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0086951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice