Healthcare Provider Details

I. General information

NPI: 1366584096
Provider Name (Legal Business Name): STANFORD L FABIO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

# 10 J EST. ST. JOHN
CHRISTIANSTED VI
00821-1786
US

IV. Provider business mailing address

#10 J EST. ST. JOHN P.O. BOX 1786
CHRISTIANSTED VI
00821-1786
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-8155
  • Fax: 340-778-7082
Mailing address:
  • Phone: 340-778-8155
  • Fax: 340-778-7082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number455
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: