Provider Demographics
NPI:1043419864
Name:STANNARD, JEFFREY BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:STANNARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1808
Mailing Address - Country:US
Mailing Address - Phone:315-478-1001
Mailing Address - Fax:315-471-1683
Practice Address - Street 1:1001 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1808
Practice Address - Country:US
Practice Address - Phone:315-478-1001
Practice Address - Fax:315-471-1683
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0359471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics