Healthcare Provider Details

I. General information

NPI: 1285670067
Provider Name (Legal Business Name): JOHN G STANLEY M.D., D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 TYLER PKWY SUITE 4
BISMARCK ND
58503-0871
US

IV. Provider business mailing address

2331 TYLER PKWY SUITE 4
BISMARCK ND
58503-0871
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-4000
  • Fax: 701-255-1992
Mailing address:
  • Phone: 701-255-4000
  • Fax: 701-255-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1983
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: