Provider Demographics
NPI:1114020385
Name:JAMES H STANFORD DDS PC
Entity Type:Organization
Organization Name:JAMES H STANFORD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:636-256-3559
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63022-0137
Mailing Address - Country:US
Mailing Address - Phone:636-256-3559
Mailing Address - Fax:636-256-9879
Practice Address - Street 1:663 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7723
Practice Address - Country:US
Practice Address - Phone:636-256-3559
Practice Address - Fax:636-256-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0143461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty