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General NPI Number Information
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NPI Number | 1922477462
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Entity Type | Organization
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Legal Business Name | DR. ROBERT J. STANCILL, DDS, MS, PLLC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 4601 LAKE BOONE TRL STE 2A
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City | RALEIGH
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State | NC
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Zip | 27607-7503
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Country | US
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Telephone | 919-239-4940
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Fax | 919-322-0503
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Provider Business Mailing Address
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Address Line | 4601 LAKE BOONE TRL STE 2A
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City | RALEIGH
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State | NC
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Zip | 27607-7503
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Country | US
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Telephone | 919-239-4940
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Fax | 919-322-0503
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT J. STANCILL
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Credential | DDS, MS
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Telephone | 919-239-4940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 5880
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License Number State | NC
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