Provider Demographics
NPI:1730277013
Name:STOVALL, SANDRA MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIA
Last Name:STOVALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9748
Mailing Address - Country:US
Mailing Address - Phone:704-549-5600
Mailing Address - Fax:704-549-9577
Practice Address - Street 1:8420 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9748
Practice Address - Country:US
Practice Address - Phone:704-549-5600
Practice Address - Fax:704-549-9577
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice