Provider Demographics
NPI:1811175318
Name:DIMITROVA-MUNRO, STELA NINKOVA I (DDS)
Entity type:Individual
Prefix:DR
First Name:STELA
Middle Name:NINKOVA
Last Name:DIMITROVA-MUNRO
Suffix:I
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 E YUCCA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2628
Mailing Address - Country:US
Mailing Address - Phone:602-996-8066
Mailing Address - Fax:
Practice Address - Street 1:3435 OCEAN PARK BULV.
Practice Address - Street 2:SUITE205
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405
Practice Address - Country:US
Practice Address - Phone:877-375-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist