Provider Demographics
NPI:1154693984
Name:RUSSELL V STOVER, DDS, PC
Entity type:Organization
Organization Name:RUSSELL V STOVER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:V
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-221-9334
Mailing Address - Street 1:326 S EDMONDS #105
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067
Mailing Address - Country:US
Mailing Address - Phone:972-221-9334
Mailing Address - Fax:972-436-7130
Practice Address - Street 1:326 S EDMONDS #105
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067
Practice Address - Country:US
Practice Address - Phone:972-221-9334
Practice Address - Fax:972-436-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty