Healthcare Provider Details

I. General information

NPI: 1023947322
Provider Name (Legal Business Name): STAFFORD DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N AIRPORT RD STE 1
JASPER AL
35504-2516
US

IV. Provider business mailing address

300 N AIRPORT RD STE 1
JASPER AL
35504-2516
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-6700
  • Fax:
Mailing address:
  • Phone: 205-221-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MYRA STAFFORD
Title or Position: PRESIENT
Credential: DMD
Phone: 205-221-6700