Provider Demographics
NPI:1184733842
Name:STEPHEN L STILLER DDS PC
Entity type:Organization
Organization Name:STEPHEN L STILLER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:812-948-5930
Mailing Address - Street 1:3525 PAOLI PIKE
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119
Mailing Address - Country:US
Mailing Address - Phone:812-948-5930
Mailing Address - Fax:812-948-5931
Practice Address - Street 1:3525 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119
Practice Address - Country:US
Practice Address - Phone:812-948-5930
Practice Address - Fax:812-948-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008519A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty