Healthcare Provider Details

I. General information

NPI: 1114908530
Provider Name (Legal Business Name): DAVID RAY STANLEY D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE STE S202
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

875 UNION AVE STE S202
MEMPHIS TN
38103-3513
US

V. Phone/Fax

Practice location:
  • Phone: 615-482-5078
  • Fax:
Mailing address:
  • Phone: 615-482-5078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6834
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: