Provider Demographics
NPI:1952303869
Name:STOCH, RUSSELL BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:BRIAN
Last Name:STOCH
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 1:840 US HIGHWAY 1
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3830
Mailing Address - Country:US
Mailing Address - Phone:561-627-4040
Mailing Address - Fax:561-624-5881
Practice Address - Street 1:840 US HIGHWAY 1
Practice Address - Street 2:STE 200
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3830
Practice Address - Country:US
Practice Address - Phone:561-627-4040
Practice Address - Fax:561-624-5881
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN89911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics