Provider Demographics
NPI:1831249135
Name:STOBERT DENTAL PC
Entity type:Organization
Organization Name:STOBERT DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRILYN
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:STOBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-258-9061
Mailing Address - Street 1:303 N CEDAR ST
Mailing Address - Street 2:PO BOX 69
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-8424
Mailing Address - Country:US
Mailing Address - Phone:231-258-9061
Mailing Address - Fax:231-258-9497
Practice Address - Street 1:303 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-8424
Practice Address - Country:US
Practice Address - Phone:231-258-9061
Practice Address - Fax:231-258-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010177391223G0001X
MI29010177451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty