Provider Demographics
NPI:1780755520
Name:LARIS A STUMPOS DDS PC
Entity type:Organization
Organization Name:LARIS A STUMPOS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-844-8060
Mailing Address - Street 1:3950 S ROCHESTER RD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-844-8060
Mailing Address - Fax:248-844-8070
Practice Address - Street 1:3950 S ROCHESTER RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-844-8060
Practice Address - Fax:248-844-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI177201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBS8199348OtherDEA