MEDICARE: JACQUELYN ANN STANFIELD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16097	TX

General Provider Information

NPI Number	:	1003818170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN ANN STANFIELD D.D.S.

Provider Business Mailing Address
First Line	:	3401 CROSS TIMBERS RD
Second Line	:	STE 100
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2900
Country	:	US
Telephone Number	:	972-355-2273
Fax Number	:	972-539-8568

Provider Business Practice Location Address
First Line	:	3401 CROSS TIMBERS RD
Second Line	:	STE 100
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2900
Country	:	US
Telephone Number	:	972-355-2273
Fax Number	:	972-539-8568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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