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General NPI Number Information
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NPI Number | 1902922693
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Entity Type | Organization
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Legal Business Name | STANNARD AND STUDT DENTISTRY PC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4170 PONTIAC LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-1282
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Country | US
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Telephone | 248-673-7300
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Fax | 248-673-4614
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Provider Business Mailing Address
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Address Line | 4170 PONTIAC LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-1282
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Country | US
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Telephone | 248-673-7300
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Fax | 248-673-4614
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Authorized Official
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Title or Position | OWNER
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Name | SEAN P STANNARD
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Credential | D.D.S.
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Telephone | 248-673-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12617
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License Number State | MI
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