Provider Demographics
NPI:1871620906
Name:STOHL, JOHN R
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:STOHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274
Mailing Address - Country:US
Mailing Address - Phone:208-357-2400
Mailing Address - Fax:208-357-2414
Practice Address - Street 1:530 S STATE ST
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274
Practice Address - Country:US
Practice Address - Phone:208-357-2400
Practice Address - Fax:208-357-2414
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-40891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice