Provider Demographics
NPI:1245275015
Name:STAHLER, EMILIE THERESA (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:THERESA
Last Name:STAHLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:
Other - Last Name:STAHLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:108 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-2671
Mailing Address - Country:US
Mailing Address - Phone:580-276-3055
Mailing Address - Fax:580-276-2552
Practice Address - Street 1:108 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448-2671
Practice Address - Country:US
Practice Address - Phone:580-276-3055
Practice Address - Fax:580-276-2552
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100172970AMedicaid