Provider Demographics
NPI:1790878908
Name:STAPE, DOMINIC (DOM)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:
Last Name:STAPE
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
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Mailing Address - Street 1:9809 CANDELARIA NE
Mailing Address - Street 2:STE 3-A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112
Mailing Address - Country:US
Mailing Address - Phone:505-298-4325
Mailing Address - Fax:505-294-5407
Practice Address - Street 1:9809 CANDELARIA NE
Practice Address - Street 2:STE 3-A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112
Practice Address - Country:US
Practice Address - Phone:505-298-4325
Practice Address - Fax:505-294-5407
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM673171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist