Provider Demographics
NPI:1689718603
Name:STOFER, WILLIAM BRANDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRANDON
Last Name:STOFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 N STATE ROAD 15
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-5503
Mailing Address - Country:US
Mailing Address - Phone:574-269-1199
Mailing Address - Fax:574-269-4452
Practice Address - Street 1:3505 N STATE ROAD 15
Practice Address - Street 2:SUITE A
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-5503
Practice Address - Country:US
Practice Address - Phone:574-269-1199
Practice Address - Fax:574-269-4452
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120100741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12010074OtherSTATE LICENSE