Provider Demographics
NPI:1396122834
Name:CARLA G STAPPENBECK DDS LLC
Entity type:Organization
Organization Name:CARLA G STAPPENBECK DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:GUZMAN
Authorized Official - Last Name:STAPPENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-376-9296
Mailing Address - Street 1:120 TOWNE CENTER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2034
Mailing Address - Country:US
Mailing Address - Phone:912-376-9296
Mailing Address - Fax:912-376-9076
Practice Address - Street 1:120 TOWNE CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2034
Practice Address - Country:US
Practice Address - Phone:912-376-9296
Practice Address - Fax:912-376-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty