Provider Demographics
NPI:1700223237
Name:STODDART, STEPHANIE SIMONE (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SIMONE
Last Name:STODDART
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 1:5 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2251
Mailing Address - Country:US
Mailing Address - Phone:860-677-1316
Mailing Address - Fax:
Practice Address - Street 1:1070 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-1453
Practice Address - Country:US
Practice Address - Phone:413-241-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109711223G0001X
MADN18564721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice