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General NPI Number Information
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NPI Number | 1336163518
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Entity Type | Individual
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Provider Name | MARY LYNN STANTON DMD, FAGD
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5508 CENTRAL ST
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City | KANSAS CITY
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State | MO
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Zip | 64113-1206
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Country | US
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Telephone | 816-363-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 E LINWOOD BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64128-2226
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Country | US
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Telephone | 816-861-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2000157357
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60059
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License Number State | KS
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