Provider Demographics
NPI:1275629644
Name:STANLEY, JOHNNY RICHARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:RICHARD
Last Name:STANLEY
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 1:307D WEST 16TH
Mailing Address - Street 2:STE D
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720
Mailing Address - Country:US
Mailing Address - Phone:432-267-3657
Mailing Address - Fax:432-267-3658
Practice Address - Street 1:307D WEST 16TH
Practice Address - Street 2:STE D
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720
Practice Address - Country:US
Practice Address - Phone:432-267-3657
Practice Address - Fax:432-267-3658
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAS8801450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist