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General NPI Number Information
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NPI Number | 1750882643
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Entity Type | Individual
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Provider Name | SAMANTHA STANLEY
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 02/26/2018
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Provider Practice Location Address
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Address Line | 51299 ROMEO PLANK RD
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City | MACOMB
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State | MI
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Zip | 48042-4114
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Country | US
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Telephone | 586-697-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 9470 GRATIOT AVE
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City | COLUMBUS
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State | MI
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Zip | 48063-3612
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902016884
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License Number State | MI
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