Healthcare Provider Details

I. General information

NPI: 1437512480
Provider Name (Legal Business Name): TONY MICHAEL STANLEY JR. D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 PROMINENCE CT STE 140
DAWSONVILLE GA
30534-8938
US

IV. Provider business mailing address

5750 STEVEHAVEN LN
CUMMING GA
30028-5998
US

V. Phone/Fax

Practice location:
  • Phone: 706-265-6877
  • Fax: 866-923-3790
Mailing address:
  • Phone: 706-502-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015490
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: