Provider Demographics
NPI:1598822074
Name:R M STAGER DMD & J R COOLE DMD STAGER & COOLE DENTISTRY
Entity Type:Organization
Organization Name:R M STAGER DMD & J R COOLE DMD STAGER & COOLE DENTISTRY
Other - Org Name:STAGER & COOLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-662-2886
Mailing Address - Street 1:17 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933
Mailing Address - Country:US
Mailing Address - Phone:570-662-2886
Mailing Address - Fax:570-513-0585
Practice Address - Street 1:17 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933
Practice Address - Country:US
Practice Address - Phone:570-662-2886
Practice Address - Fax:570-513-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020654L122300000X
PADS030574L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty