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General NPI Number Information
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NPI Number | 1497048557
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Entity Type | Individual
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Provider Name | GORDON D. STABLEY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 530 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85004-1549
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Country | US
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Telephone | 602-281-9540
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Fax |
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Provider Business Mailing Address
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Address Line | 241 ROMA DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-3616
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Country | US
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Telephone | 262-716-4868
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D011616
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License Number State | AZ
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