Provider Demographics
NPI:1205854627
Name:KAUFMAN, STANLEY MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:MARK
Last Name:KAUFMAN
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 1:7917 FANTAIL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2439
Mailing Address - Country:US
Mailing Address - Phone:702-399-5956
Mailing Address - Fax:
Practice Address - Street 1:901 RANCHO LN
Practice Address - Street 2:SUITE 270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3836
Practice Address - Country:US
Practice Address - Phone:702-636-3060
Practice Address - Fax:702-636-3057
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41161223G0001X
VA35041223G0001X
NV4993T1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice