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Individual
G. VAN STOSICH
Active
Individual
G. VAN STOSICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1730
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6F233
BLUE CROSS ID
ID
01
—
D-1730
DENTIST LICENSE #
ID
Enumeration date
10/26/2006
Last updated
03/07/2023
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