Provider Demographics
NPI:1982649356
Name:STOOPLER, ERIC T (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:STOOPLER
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 1:3400 SPRUCE ST
Mailing Address - Street 2:5 WHITE BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3580
Mailing Address - Fax:215-662-7445
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:5 WHITE BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-3580
Practice Address - Fax:215-662-7445
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 035317204E00000X
PADS035317204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019246970001Medicaid
U92540Medicare UPIN
PA0019246970001Medicaid