Provider Demographics
NPI:1043357676
Name:STOKKE, HENRY BANNER (DDS)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:BANNER
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 1:24 WOODARD AVE
Mailing Address - Street 2:
Mailing Address - City:ABSAROKEE
Mailing Address - State:MT
Mailing Address - Zip Code:59001
Mailing Address - Country:US
Mailing Address - Phone:406-328-4507
Mailing Address - Fax:406-328-4507
Practice Address - Street 1:24 WOODARD AVE
Practice Address - Street 2:
Practice Address - City:ABSAROKEE
Practice Address - State:MT
Practice Address - Zip Code:59001
Practice Address - Country:US
Practice Address - Phone:406-328-4507
Practice Address - Fax:406-328-4507
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist