Provider Demographics
NPI:1780705012
Name:STOVALL, DENNIS K (DMD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:K
Last Name:STOVALL
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 1:845 N NEW BALLAS CT
Mailing Address - Street 2:340
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-993-4114
Mailing Address - Fax:314-993-0440
Practice Address - Street 1:845 N NEW BALLAS CT
Practice Address - Street 2:340
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-993-4114
Practice Address - Fax:314-993-0440
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO131921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice