Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 016-0002076 | VT |
NPI | 1023193273 |
---|---|
Provider Name | Ms. Sherilynn Stofka |
First Address | Rutland, VT 05701-3249 |
Second Address | Rutland, VT 05701-3249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |