Provider Demographics
NPI:1699221549
Name:STALLARD, ADELE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADELE
Middle Name:
Last Name:STALLARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16729 EAST COLONIAL DRIVE, SUITE 151
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820
Mailing Address - Country:US
Mailing Address - Phone:407-378-2453
Mailing Address - Fax:
Practice Address - Street 1:1580 HOOKS ST STE B
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3585
Practice Address - Country:US
Practice Address - Phone:352-292-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist