Provider Demographics
NPI:1851964001
Name:STROH, STEFAN NICHOLAS (DMD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:NICHOLAS
Last Name:STROH
Suffix:
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 1:2587 WINDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-6126
Mailing Address - Country:US
Mailing Address - Phone:904-233-4891
Mailing Address - Fax:
Practice Address - Street 1:8823 GOODBYS EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4605
Practice Address - Country:US
Practice Address - Phone:904-215-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12337282-9922122300000X
FLDN28722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist