Provider Demographics
NPI:1255371852
Name:STOFKO, ALBERT E (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:E
Last Name:STOFKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:SUITE 205
Mailing Address - Street 2:401 ADAMS AVENUE
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2025
Mailing Address - Country:US
Mailing Address - Phone:570-344-6464
Mailing Address - Fax:570-344-0999
Practice Address - Street 1:SUITE 205
Practice Address - Street 2:401 ADAMS AVENUE
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2025
Practice Address - Country:US
Practice Address - Phone:570-344-6464
Practice Address - Fax:570-344-0999
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017892L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T71902Medicare UPIN
099365Medicare PIN