MEDICARE: DR. RICHARD N. STANMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	25221	CA

General Provider Information

NPI Number	:	1952312696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD N. STANMAN DDS

Provider Business Mailing Address
First Line	:	11600 WILSHIRE BLVD
Second Line	:	SUITE 308
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5781
Country	:	US
Telephone Number	:	310-473-8770
Fax Number	:	310-477-5818

Provider Business Practice Location Address
First Line	:	11600 WILSHIRE BLVD
Second Line	:	SUITE 308
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5781
Country	:	US
Telephone Number	:	310-473-8770
Fax Number	:	310-477-5818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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