Provider Demographics
NPI:1053314856
Name:SARGENT, STANLEY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:SARGENT
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 1:3707 S GRAND BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2712
Mailing Address - Country:US
Mailing Address - Phone:509-838-2434
Mailing Address - Fax:509-623-1548
Practice Address - Street 1:3707 S GRAND BLVD
Practice Address - Street 2:STE B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2712
Practice Address - Country:US
Practice Address - Phone:509-838-2434
Practice Address - Fax:509-623-1548
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA51391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice