Individual
DR. AMY JO STODOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1630 32ND ST NE, CEDAR RAPIDS, IA 52402-4048
(319) 362-8657
(319) 362-1824
Mailing address
1630 32ND ST NE, CEDAR RAPIDS, IA 52402-4048
(319) 362-8657
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IA 08065
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2220020
—
IA
01
—
36871
BC & BS PROVIDER #
IA
01
—
IA 08065
LICENSE
IA
Enumeration date
04/06/2007
Last updated
07/09/2007
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