Provider Demographics
NPI:1720006331
Name:STOBBE, JOSEPH W JR (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:STOBBE
Suffix:JR
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 1:2979 KEMPNER RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3656
Mailing Address - Country:US
Mailing Address - Phone:801-263-7711
Mailing Address - Fax:
Practice Address - Street 1:715 E 3900 S STE 112
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2562
Practice Address - Country:US
Practice Address - Phone:801-263-7711
Practice Address - Fax:801-263-9087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1359131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5792282OtherAETNA
UT423076OtherUNITED CONCORDIA