Provider Demographics
NPI:1982151445
Name:STITELY, DEVIN COLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:COLE
Last Name:STITELY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 CEDAR CREEK GRADE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3006
Mailing Address - Country:US
Mailing Address - Phone:540-450-2210
Mailing Address - Fax:
Practice Address - Street 1:633 CEDAR CREEK GRADE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3006
Practice Address - Country:US
Practice Address - Phone:540-450-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9843122300000X, 1223G0001X
VA0401417286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice