Provider Demographics
NPI:1821521857
Name:STOFFEL, MARISA ANN (RDH)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANN
Last Name:STOFFEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32281 RIVER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93265-9633
Mailing Address - Country:US
Mailing Address - Phone:760-267-4464
Mailing Address - Fax:
Practice Address - Street 1:101 N PALM ST
Practice Address - Street 2:
Practice Address - City:WOODLAKE
Practice Address - State:CA
Practice Address - Zip Code:93286-1422
Practice Address - Country:US
Practice Address - Phone:559-564-1100
Practice Address - Fax:559-564-1101
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH30873124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist