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General NPI Number Information
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NPI Number | 1669786430
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Entity Type | Individual
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Provider Name | JESSE ALLEN STAFFORD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 01/31/2021
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Provider Practice Location Address
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Address Line | 516 W ARAPAHO RD STE 103
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City | RICHARDSON
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State | TX
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Zip | 75080-4342
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Country | US
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Telephone | 972-231-5020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 124
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City | PLUMTREE
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State | NC
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Zip | 28664
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Country | US
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Telephone |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 32443
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 9243
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License Number State | NC
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