Provider Demographics
NPI:1023355005
Name:STOTLER, JODI LEE (RDH)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LEE
Last Name:STOTLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7387
Mailing Address - Country:US
Mailing Address - Phone:573-327-8010
Mailing Address - Fax:573-327-8012
Practice Address - Street 1:2820 ANCHOR DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-7387
Practice Address - Country:US
Practice Address - Phone:573-327-8010
Practice Address - Fax:573-327-8012
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015343124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist