Provider Demographics
NPI:1881772846
Name:STOKKE, SAMUEL LEE (DDS)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LEE
Last Name:STOKKE
Suffix:
Gender:M
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:PO BOX 356
Mailing Address - Street 2:112 1ST AVE SO
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-3359
Mailing Address - Country:US
Mailing Address - Phone:406-628-8211
Mailing Address - Fax:406-628-4423
Practice Address - Street 1:112 1ST AVE SO
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3359
Practice Address - Country:US
Practice Address - Phone:406-628-8211
Practice Address - Fax:406-628-4423
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT112944Medicaid
MT5512702OtherBLUE CHIP