Provider Demographics
NPI:1073730040
Name:STANTON, CAROL MUMMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:MUMMA
Last Name:STANTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BEAVERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7832
Mailing Address - Country:US
Mailing Address - Phone:732-920-3333
Mailing Address - Fax:732-920-2219
Practice Address - Street 1:17 BEAVERSON BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7832
Practice Address - Country:US
Practice Address - Phone:732-920-3333
Practice Address - Fax:732-920-2219
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01368500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist