Provider Demographics
NPI:1588866347
Name:STOKER, DAVID STEPHEN (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:STEPHEN
Last Name:STOKER
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 1:4190 S HIGHLAND DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-272-9241
Mailing Address - Fax:801-277-9760
Practice Address - Street 1:4190 S HIGHLAND DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-272-9241
Practice Address - Fax:801-277-9760
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78111223S0112X
UT696130199241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45642UMedicare UPIN