Provider Demographics
NPI:1821831116
Name:STOFER, KEELY MARIE (DDS)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:MARIE
Last Name:STOFER
Suffix:
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 1:805 DIVISION ST APT 808
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5970
Mailing Address - Country:US
Mailing Address - Phone:501-701-0484
Mailing Address - Fax:
Practice Address - Street 1:2641 8TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2483
Practice Address - Country:US
Practice Address - Phone:615-784-5104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist