Provider Demographics
NPI:1063954642
Name:STOLTENBERG DENTAL PLLC
Entity type:Organization
Organization Name:STOLTENBERG DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADEN
Authorized Official - Middle Name:HOFMAN
Authorized Official - Last Name:STOLTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-406-1529
Mailing Address - Street 1:4503 GREEN FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3131
Mailing Address - Country:US
Mailing Address - Phone:405-406-1529
Mailing Address - Fax:
Practice Address - Street 1:707 24TH AVE SW STE 201
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3957
Practice Address - Country:US
Practice Address - Phone:405-364-6064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6118261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental