MEDICARE: DR. CECIL PHILLIP STANCIL JR. 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN013667	GA

General Provider Information

NPI Number	:	1982880639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECIL PHILLIP STANCIL JR. D.D.S.

Provider Business Mailing Address
First Line	:	7118 SONYA DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-5232
Country	:	US
Telephone Number	:	615-207-1932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1147 S HAIRSTON RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2716
Country	:	US
Telephone Number	:	404-297-6635
Fax Number	:

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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