MEDICARE: DR. LAURIE ANNE STANELL D.M.D

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	122300000X	Dentist	DS024879L	PA

General Provider Information

NPI Number	:	1033129705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE ANNE STANELL D.M.D

Provider Business Mailing Address
First Line	:	4950 YORK RD
Second Line	:	PO BOX 708 SUITE 2-H
City	:	HOLICONG
State	:	PA
Zip	:	18928-6000
Country	:	US
Telephone Number	:	215-794-3898
Fax Number	:	215-794-9082

Provider Business Practice Location Address
First Line	:	4950 YORK RD
Second Line	:	4950 YORK ROAD SUITE 2-H
City	:	HOLICONG
State	:	PA
Zip	:	18928-6000
Country	:	US
Telephone Number	:	215-794-3898
Fax Number	:	215-794-9082

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	12/10/2020

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