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General NPI Number Information
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NPI Number | 1700260692
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Entity Type | Organization
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Legal Business Name | STANSBERRY FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 7501 N. 16TH ST. #100
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City | PHOENIX
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State | AZ
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Zip | 85020
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Country | US
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Telephone | 602-944-9197
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Fax |
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Provider Business Mailing Address
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Address Line | 7501 N 16TH ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85020-4677
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Country | US
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Telephone | 602-944-9197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TROY STANSBERRY
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Credential | DDS
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Telephone | 602-944-9197
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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 | 7489
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License Number State | AZ
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