Dr. Stephanie D Joly, D.D.S
Dentist, General Practice in Portage, IN. Individual provider (NPI-1).
NPI number1760630610
StatusActive
Last updated in NPPESJan 11, 2022
Details
- NPI
- 1760630610
- Entity type
- Individual (NPI-1)
- Name
- Dr. Stephanie D Joly
- Credential
- D.D.S
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 4, 2008
- Certification date
- Jan 11, 2022
- Last updated
- Jan 11, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 12011254A | IN | Yes |
| 1223G0001X | Dentist, General Practice | 019.027751 | IL |
Practice location
2646 Lois StPortage, IN 46368-3500
Phone 219-762-4266 · Fax 219-762-2252
Mailing address
2646 Lois StPortage, IN 46368-3500
Phone 219-762-4266 · Fax 219-762-2252
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