Provider Demographics
NPI:1194015594
Name:STANLEY, JEFFREY VANCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:VANCE
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6465 N PALM AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1085
Mailing Address - Country:US
Mailing Address - Phone:559-435-6465
Mailing Address - Fax:559-435-5504
Practice Address - Street 1:6465 N PALM AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1085
Practice Address - Country:US
Practice Address - Phone:559-435-6465
Practice Address - Fax:559-435-5504
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics